


KSiy^» 












=^.- 






$0: 



LIBRARY OF CONGRESS. 






UNITED STATES OF AMERICA. 



VAGARIES 



OF 



Sanitary Science 



F. L DIBBLE, M.D. 



It is held as a fundamental principle in science that every opinion, before it 
is admitted as true and taught to others, should first be established by proper 
proofs, which must not in any way run counter to established truths, such as, 
for instance, that twice two are four and not five. Inferences and conclusions 
which are opposed to such truths are rejected by science. — Liebig. 







PHILADELPHIA 

J. B. LIPPINCOTT COMPANY 
1893 



V a 



3' 



Copyright, 1893, 

BY 

J. B. LippiNcoTT Company. 



Printed by J. B. Lippincott Company, Philadelphia. 



THIS BOOK 



IS DEDICATED WITH PROFOUND RESPECT 



WORKINGMEN 



OF THE 



MEDICAL PROFESSION. 



CONTENTS 



PAGE 

Introductory 7 

CHAPTER I. 
Sanitarians — Ancient, Mediaeval, and Modem 15 

CHAPTER II. 

The Great Sanitary Awakening, with an Account of some of the Circum- 
stances which attended the Birth of Sanitary Science ♦ 29 

CHAPTER III. 
The Air 50 

CHAPTER IV. 
The Air (continued) 79 

CHAPTER V. 
The Water 106 

CHAPTER VI. 
The Soil . 142 

CHAPTERVII. 
The Sewer-Gas 153 

CHAPTER VIII. 
Cemeteries 181 



CHAPTER IX. 

' '^* 5 



Public Funerals 205 



6 CONTENTS. 

CHAPTER X. PAGE 

The Meat 215 

CHAPTERXI. 
The Milk , 231 

CHAPTER XII. 
Filth and Fecal Diseases— Typhoid Fever 248 

CHAPTER XIII. 
Yellow Fever . 280 

CHAPTER XIV. 
Cholera 292 

CHAPTER XV. 
Diphtheria 329 

CHAPTER XVI. 
Epidemics 345 

CHAPTER XVII. 
Boards of Health 364 

CHAPTER XVIII. 
The Vital Statistics 403 

CHAPTER XIX. 
Conclusion 454 



INTRODUCTORY. 



About five years ago, during an hour of leisure, the 
author of this book took up an annual report of a local 
board of health and read it. It was full of general misstate- 
ments and inconsistencies, and abounded in misrepresenta- 
tions of vital statistics. Yet this erratic and unreliable 
report was offered to scientific men, and to the medical 
profession, as a truthful exhibit of the value and working of 
Sanitary Science. On the strength of this report, the law- 
making power, to which it was addressed, was besought, in 
the name of the Public Safety, to formulate the most offen- 
sive and despotic legislation, to create new offices and to 
levy new taxes. The author was impelled, in a spirit of 
badinage, to publish anonymously in a newspaper a review 
of the document. 

The sonorous and impressive titles of State Medicine, 
Preventive Medicine, Sanitary Reform, Sanitary Science, and 
their relation to the great question of the public health 
had always been deeply ingrained in his mind. The object 
which these titles represented surpassed in importance all 
considerations of therapeutics as applied to individual 
patients in the daily practice of medicine, as much as ques- 
tions of national life exceeded those of the welfare of private 
persons. 

The author felt that in reviewing this report in a mirthful 
way he had done an unholy thing: he had trifled with the 
public health, had mocked its ministers who were organized 
as a board, and who were supposed to be calmly but deeply 

7 



8 INTRODUCTORY. 

meditating on the cause of those diseases which the medical 
profession had hitherto been unable to fathom, and which 
cause, as it was exposed to view by the light of Sanitary- 
Science, they made known to a world sitting in darkness. 
The author believed that the report which he had criticised 
had been carelessly gotten up by its makers (they were his 
professional and personal friends, as friends go), and had 
glided from their hands without their being aware of its 
incongruities. He never doubted for a moment the merits 
of State Medicine and Sanitary Science, and in treating them 
lightly felt that he merited, and he expected to receive, a 
condign punishment. 

His remorse was something like it would have been if, 
fifty years ago, he had laughed at his Sunday-school teacher, 
who in his ministrations had inadvertently donned a bad hat 
or worn a patched coat. 

As by unexpected impunity wicked men are often em- 
boldened to continue their transgressions, so the author's 
unlooked-for escape from chastisement encouraged him to 
go farther, and he reviewed a report of a State board of 
health, which was even fuller and fatter with nonsense than 
was that of the city board. 

This kind of skirmishing went on for a year or two ; shot 
after shot was fired in vain in the hope of drawing the 
ammunition from the sanitarians, when finally a reply came 
which in no way vindicated the absurdities nor explained 
the inaccuracies of their printed reports, but which was a 
biting taunt that the reviewer was an enemy of the public 
health. Besides, it was more than hinted, in a subsequent 
report, that the progress of Preventive Medicine was ob- 
structed by those physicians who saw in its ultimate triumph 
a diminution of their own revenues. 

It occurred to the author that if strictures on Sanitary 
Science could be replied to only with taunt and innuendo, 
it was fundamentally defective; so that, although his so 



INTROD UCTOR Y. 9 

doing implied a doubt of the infallibility of its professors, 
and although it might indicate an irreverent spirit and lay 
him open to the reiterated charge of being an enemy of the 
public health, he ventured to look up its history and ex- 
amine its claims to be considered a science. He found that 
it had its origin in a kind of disorderly agitation that sud- 
denly seized the people of Great Britain, following an inquiry 
into the condition and manners of living of the poorer 
classes in that country. Sanitary reform was not conse- 
quent to any new biological or pathological discovery; 
neither was it connected with any line of scientific research. 
It owed its rise and progress in our own land more to the 
fondness and habit of imitating the English than to any 
other cause. In both countries, although its inception was 
perhaps unalloyed by selfishness, speculators within and 
without the medical profession were quick to discern and 
grasp the opportunity to be cheaply lifted to fame and 
fortune, and, stimulated in this way by self-interest, when 
the excitement was well under way, its momentum was 
irresistible. 

The theme of the whole movement was the causation by 
filth of infectious disease ; and the phenomena of zymosis 
were so treated as to explain the origin of such disease. It 
was boldly declared by the reformers that filth — organic 
matter in decomposition and fermentation — ^^was capable of 
exciting in the human system fermentative, zymotic, filth 
diseases, and these epithets were applied to all of those 
which had in them the element of contagion or infection. 
Zymotic disease was therefore preventable through the 
removal of filth and the hinderance of zymosis, and the 
science of Preventive Medicine was reared on this fantastic 
idea, which for the last fifty years has formed the basis of 
all sanitary legislation in Great Britain and America. It 
was never pretended that this whimsical theory had any 
foundation in scientific inquiry, and it never had the sanction 



I O INTR OD UCTOR Y. 

of thoughtful and practical men in the medical profession. 
Dr. Farr, who was one of the first, if not the first, to apply 
the term zymotic to disease, was careful to say that he 
used it only because it was more convenient than the pe- 
riphrasis of epidemic, endemic, and contagious diseases. 

At the very outset of his labors the author was struck 
with astonishment at the almost utter barrenness, on the 
part of the sanitarians, of anything like scientific investi- 
gation. Not less surprising was this other fact, — namely, 
that if perchance — which rarely happened — an investigation 
which merited the name scientific was by themselves under- 
taken, or, what was oftener the case, if a genuinely scientific 
inquiry into their pretensions was made by scientific men, 
the result, in either case, invariably was their complete 
overthrow. 

From time to time a sanitary orator at a sanitary con- 
vention would improvise some wild proposition about the air, 
water, and soil, or would indulge in some strange phantasy 
respecting the sewers, the cemeteries, or the markets ; this 
would be wafted with great thoracic vehemence from the 
larynx of one reformer to that of another, — nobody would 
investigate its truth or falsity, — soon it would find an echo 
in some sanitary journal, and straightway would be given 
a place among the " settled principles of Sanitary Science." 

If any resistance were offered to these vain imaginings, 
it was not listened to in a scientific spirit ; but the opponent 
was censured as a foe to the public health, and if he re- 
sented this imputation, he was hushed by the reproach that 
he was an advocate of uncleanliness, and, as we shall see 
later, was said to be " content to wallow in his own filth." 

The author's amazement had no bounds when, on ex- 
amining, one after another, the " settled principles of Sani- 
tary Science," he found that these had no scientific basis ; 
that they rested on froth, noise, and panic, and that the 
shapeless spectres which the reformers had raised to in- 



INTRODUCTORY. II 

timidate the public disappeared when they were looked 
squarely in the face. 

The whole sanitary movement had no resemblance to 
scientific investigation ; it could be likened only to a politi- 
cal upheaval or a fanatical religious awakening. Indeed, it 
can be fitly compared with the imposition on mankind of 
those false religions whose priests have held, at different 
periods of the world's history, whole continents in terror by 
their inventions. As, in order to sustain these false religions, 
it was necessary that their ministers should continually re- 
inforce them with some new dogma, so the vigor and stability 
of Sanitary Science depended on the ingenuity of its pro- 
moters to persistently summon up some new terror with 
which to frighten the people, and then proceed to caress 
them into tranquillity by the passage of some sanitary ordi- 
nance or by the pretended discovery of some antidote or 
antiseptic. These successive conjurations, combined with 
legislative enactments which imparted to them force, were 
called the " gigantic strides of Sanitary Science," 

There have been times during the progress of this work 
when the author has doubted the evidence of his senses. 
More than once, in order to be convinced that his own eyes 
did not deceive him, he has laid before others the state- 
ments and figures of professional sanitarians which were so 
absurd, so self-contradictory, that it did not seem possible 
that they could have emanated elsewhere than from the 
brain of a lunatic or an imbecile. When pressed to explain 
their tissues of paradox and absurdity, the reasons which 
they gave were often so trivial that if, in a well-regulated 
household, similar ones had been offered to soothe the 
budding curiosity of a nursling, its attendant would have 
been visited with reproof if not with summary dismissal. 

The author has often felt a sense of shame that many of 
those who were foisting this sanitary nonsense on the people, 
and on physicians, and demanding that it be embodied in 



12 INTRODUCTORY. 

statute law, were nominally of the medical profession. In 
the beginning of this inquiry, he had no thought of pub- 
lishing its result. But, as the work proceeded, he became 
more and more impressed with its gravity, not only to 
medical men, but to the public at large. He esteems that 
an important point has been gained if he shall succeed in 
calming the fears, quieting the panics, and restoring the 
composure of his fellow-citizens, whose minds have been 
continuously excited and kept at a painful tension by sani- 
tary reformers, concerning the dangers of air, water, soil, 
cemeteries, markets, public and private improvements, and 
if he has shown that none of these, in the conditions in 
which they have been set forth by the pretended guardians 
of the public health, are causes of disease, and especially of 
infectious disease. 

In the main, in this work, the author has drawn no con- 
clusions ; he has submitted facts. That these facts are to 
his own mind demonstrative, that they have changed en- 
tirely his former belief in the etiology of infectious disease, 
he makes no effort to conceal. It was never anything but 
a ** belief" transmitted to him by oracular men who had no 
claim to be considered scientific. If, sometimes, he has 
betrayed a warmth of expression, it is because of natural 
indignation that he had not only been the dupe of noisy 
men who were posing as scientists, but that through their 
teachings he had been the instrument of duping others. 

If the objection be raised that the conclusions to which 
the facts here presented tend shatter the faith in Sanitary 
Science and leave the public health comfortless and the 
people nothing to lean upon, the reply is, that if the faith 
be false it should be discarded ; that in natural science an 
intelligent agnosticism is better than blind credulity in error, 
especially when the subject is of such weighty moment to 
humanity as knowledge of the causes of disease. Though 
in theological matters it may be debatable (in many minds 



INTRODUCTORY. 13 

it IS firmly settled) that mankind is happier with a false 
belief than with none at all, a like conviction has never 
obtained in questions of physical inquiry, and it will not 
be denied that one of the first steps towards ascertaining 
the truth is to expose and remove error. Neither will it be 
disputed that the virgin mind, untainted in its sincerity, is 
fitter for the reception of truth, when this is made known, 
than is the mind which is clogged and darkened by false- 
hood. 

If further opposition be made, that the display of these 
facts will expose the pretensions of a large number of pro- 
fessional sanitarians, who, by playing on the fears of their 
fellow-men, have acquired fame and position ; and that it 
will wound a large number of amateurs of both sexes who 
have been seduced into dabbling and coquetting with Sani- 
tary Science, for the reason that it required no mental 
labor to become proficient in its mysteries, and who have 
found therein a solace for their ennui^ the reply is, that the 
objection is well taken, and from a social point should be 
considered, but should not be sustained in view of the vast 
importance to the people that no errors should be confirmed 
regarding the pubHc health ; and, moreover, attractive fields 
are being continually thrown open, which offer an ample 
refuge to that large class of minds which seek intellectual 
repose in improvisation rather than in scientific research. 

Those to whom truth is distasteful, lest it shall shock a 
life-long prejudice, are advised not to read this work, — it 
will only irritate them. It had better remain closed to 
those who fear that they will sink into depravity should 
they listen to evidence respecting the innocence of nature's 
metamorphoses. Those are cautioned not to open it who, 
though feeling secure in their own virtue, are so solicitous 
and apprehensive for the vulnerability of that of their 
neighbors, lest they retrograde in civilization and prefer 
nastiness to elegance unless their minds are steadily tortured 

2 



14 INTRODUCTORY. 

with hideous fables of disease and death. On the other 
hand, those timid people who for the last thirty years have 
had their waking hours vexed and their sleep plagued by 
an unceasing procession of sanitary terrors are invited to 
read it. It may comfort them. Those also are invited to 
read it who love truth for truth's sake, and who believe 
themselves sufficiently steadfast to receive it, and who can 
survey nature's changes in decay and death, not only with 
the same composure but with the same poetic fervor that 
they view her creative and formative processes, without im- 
agining, in the absence of all proof, that these mutations are 
inseparable from the explosion of epidemic disease. 



VAGARIES 



OF 



SANITARY SCIENCE. 



CHAPTER I. 
Sanitarians — Ancient, Mediaeval, and Modern. 

That instinct of self-preservation, the most powerful of 
all instincts, which is ever active with the individual, making 
him timid or courageous in the presence of danger, espe- 
cially the danger of epidemic and infectious disease, extends 
itself with no less potency to collective bodies of men for 
the conservation of communities, nations, and races. 

Man is hardly conscious of life when he begins to be 
tormented with the fear of death. His hope of a continued 
being and a fear of its extinction have often overcome rea- 
son and judgment, and have made him the dupe of the pre- 
tender and the charlatan in all ages. 

The most primitive people of whom we have any historic 
records, even in their transit through the wilderness, sub- 
mitted to as stringent sanitary codes as any of those which 
have been contrived in our own time. It was doubtless a 
prophylactic ordinance which marked the Jew with a fleshly 
sign that distinguished him from the rest of mankind. By 
the fifteenth day of the second month of their journey the 
Israelites had begun to worry about their health. The 
cloud yet rested on the tabernacle by day and the fire 

IS 



1 6 VAGARIES OF SANITARY SCIENCE. 

blazed on it by night to guide the exiles in the desert, when 
their leader and prophet put forth a system of dietetics 
which, to a great extent, is observed by their descendants to 
the present day. Birds, beasts, insects, reptiles, and fish 
were proscribed which the experience of all other peoples 
has proved to be harmless; others were allowed and even 
commanded to be eaten from which we turn with disgust. 
The camel, the cony, the hare, and the swine were forbid- 
den ; they were unclean ; not only were these and everything 
in the waters that had not fins and scales denounced as an 
abomination, but the decree went further, ** Ye shall have 
their carcasses in abomination." They might eat the sheep, 
the ox, the goat, the deer, and the pygarg, and the locust and 
the bald locust, the beetle and the grasshopper, but " any 
creeping thing that creepeth" they should not be defiled 
thereby. They should not eat the blood, for the blood was 
the life. Neither should they eat any<-hing that had died of 
itself This they might sell to the alien or give unto the 
stranger. Experience and observation had probably taught 
their guide that the flesh of animals dead of disease was 
innoxious, for he had long before counselled them to love 
the stranger, reminding them that they, too, had been stran- 
gers in the land of Egypt. But his delicate and fastidious 
mind would not tolerate such food for the Jew. His people 
were a peculiar people, and his God was a jealous God. 

Attempts have been made to show that the aim of the 
prophet sanitarian was to set forth in these mandates the 
virtues of self-restraint and temperance. This can hardly 
be so ; for when the wanderers languished and murmured 
by the way, his method of infusing new courage into their 
hearts was by appealing to their appetites. If any message 
had been given to him from the flaming bush of the life 
eternal, he spoke not a word of it to the materialistic Jew. 
Many times he told his followers that he was conducting 
them to a land flowing with milk and honey, where they were 



SANITARIANS— ANCIENT, MEDIAEVAL, AND MODERN. 1/ 

to eat and fill themselves and wax fat ; and as they approached 
the river where he was to lay down his leadership and find 
an unmarked grave, he burst forth into a victorious song and 
laid before them a rich but unclassified menu, that Jew might 
taste with delight and that Gentile might adore. For the 
Lord had made Jacob to " ride on the high places of the 
earth, that he might eat the increase of the fields ; and he 
made him to suck honey out of the rock, and oil out of the 
flinty rock ; butter of kine, and milk of sheep, with fat of 
lambs, and rams of the breed of Bashan, and goats with the 
fat of kidneys of wheat ; and thou didst drink the pure blood 
of the grape." This sacerdotal hygiene took cognizance of 
the most secret relations of life. If a man or a woman had 
an issue, separation from the rest was enjoined for a stated 
period. The etiology of disease was in the fiat of Jehovah. 
The priest diagnosticated the malady, prescribed the treat- 
ment, made the prognosis, supervised the convalescence. 

The therapeutics of the Hebrews of that day would be 
no more acceptable to us than their prophylactic measures 
and their dietetics. The blood of the trespass-offering was 
to be put on the tip of the right ear of him that was to be 
cleansed of the leprosy, and upon the thumb of his right 
hand and upon the great toe of his right foot. When the 
wandering children were bitten by fiery serpents, they had 
but to look on the brazen serpent that their leader lifted up 
and they lived. If they were faithful to the statutes and 
commandments, they should not suffer the diseases that had 
been brought on the Egyptians. But if they did not keep 
the laws, " then the Lord will make thy plagues wonderful,, 
and the plagues of thy seed, even great plagues, and of long 
continuance, and sore sicknesses, and of long continuance.'* 
"The Lord will smite thee with the botch of Egypt, and 
with the emerods, and with the scab, and with the itch, 
whereof thou canst not be healed." 
\ Many centuries later appeared another sanitarian, a leg- 

b 2* 



1 8 VAGARIES OF SANITARY SCIENCE. 

islator in the person of Lycurgus. His prophylaxis was 
of the most radical kind. The new-born Spartan child 
which gave no promise of future vigor was abandoned or 
destroyed. If permitted to live, not long after it had been 
weaned from the mother breast it was seized by the state, 
removed from the family, and made a part of the common 
stock. It was subjected to influences and exercises to 
strengthen and indurate bone and muscle and nerve. A 
public table supplied by the simplest food nourished the 
bodies of the Spartan youth. Those mental qualities which 
tended to self-preservation were stimulated and encouraged. 
Lying was a virtue and theft a duty. When the Spartan 
brave made love, he sought and won his bride by stealth 
and violence ; and the first-born of Spartan children were 
the product of a rape. Marriage could not be contracted 
by men before thirty, nor by women under twenty years of 
age. When the Spartan woman was likely to become a 
mother, the pictures of the handsomest young men were 
hung in her chamber, that gazing on them might produce 
a favorable effect on the child. That this system of legis- 
lative hygiene, which in our day would bear the pompous 
title of State Medicine, was effective to establish a vigorous 
body will not be denied. The Spartans were a healthy but 
a bad lot. 

Five hundred years later appears a man whose deep phi- 
losophy is set forth in such sententious phrase as, " Life is 
short, and art is long ; the occasion fleeting ; experience 
fallacious, and judgment difficult." He displayed such 
practical knowledge of the art of medicine that his works 
have been studied and admired for more than twenty-three 
centuries. The modern sanitarians, in their retrospective 
excursions to seek in antiquity a warrant for the vagaries 
and chimeras of their own creation, rest fondly on Hippoc- 
rates II. or the Great. In his book on " Airs, Waters, and 
Places," they find, or pretend to find, a treatise on hygiene. 



SANITARIANS— ANCIENT, MEDIMVAL, AND MODERN. 1 9 

whose title they have transformed into their own shibboleth 
of " pure air, pure water, pure soil," as the essentials of 
public health. That they have never read or that they 
misrepresent the Great Father is plain, for there is abso- 
lutely nothing in his book on " Airs, Waters, and Places" 
that can possibly be twisted to the modern sanitarians' use. 
Their prototypes belong to the charlatans of an earlier and 
a later age. 

A thousand years have rolled on from the time of Hippoc- 
rates, when the mediaeval sanitarian arises to teach and 
guide his fellow-man in the maintenance and promotion of 
his health. The school of Salerno, in the tenth century, 
emits hygienic maxims in Leonine rhymes, which afford 
amusement, if not instruction, to the reader of to-day. This 
famous body, which existed for centuries, seems to have 
been entirely neglected by the modern sanitarians, for we 
do not remember ever to have seen it alluded to in any of 
their writings. In some of the apothegms of this school 
they will find a counterpart of their watchwords, " pure air, 
pure water, pure soil," sometimes done into English, some- 
times into French verse. In pestilential times the astute, 
mediaeval reformer discovered the etiology of epidemics in 
the machinations of the Jews, and his prophylaxis consisted 
in first robbing and then roasting and hanging these un- 
happy people. 

From the Middle Ages to the present time are strewn 
accounts of efforts to promote the public health, — all or 
nearly all, however, founded on false notions of the etiology 
of the diseases which these endeavors sought to control. 
It cannot be gainsaid that the Mosaic theory of the etiol- 
ogy of epidemics — to wit, the Divine will — can be less suc- 
cessfully contradicted than any invented by the sanitary 
reformers. 

The feebleness of sanitarians and boards of health so 
impressed Noah Webster that he declared in his work on 



20 VAGARIES OF SANITARY SCIENCE. 

epidemics, a hundred years ago, that he found " no suffi- 
cient evidence that health laws ever saved a country or city 
from pestilence in a single instance; but abundant, positive 
proof of their inefncacy in a great number of cases ;" and 
he remarks that men have perished by millions in the most 
salubrious regions, exposed to no local causes of disease 
whatever, except such as exist in the most healthy periods. 
In the progress of this work we expect to show that, not- 
withstanding the boasts of the sanitary reformer of to-day, 
his methods of dealing with pestilence in its relation to 
public health are almost exactly like those of ancient and 
mediaeval times. But our business in these pages is to con- 
sider the rise and progress of the modern sanitarian, and 
particularly as he exhibits himself in our own country. 
Twenty-five years ago he was in embryo. The ferment 
about sanitary reform, which had existed in England for a 
quarter of a century before, had just reached our shores. 
There was then no occasion for alarm about the public 
health. There was no reason to doubt that here, as else- 
where in the civilized world, the general death-rate of hu- 
man beings was diminishing ; that the mean duration of life 
was being extended ; and that, too, except through a gen- 
eral advancement in civilization, it was being accomplished 
independent of any known human agency. But the occa- 
sion was ripe for noisy, superficial men to be heard, and 
these commenced to bring themselves into prominence as 
scientists. They began to prate loudly of air, water, and 
soil. These elements, indispensable to life, were pestilential, 
polluted, contaminated. Towns and cities which had been 
renowned for centuries for their health were suddenly dis- 
covered to be the breeding-places of epidemic disease. 
Suspicion was cast on sources of water-supply which for 
generations had furnished a delicious and healthful bever- 
age. The reformers told us that the very fact that these 
waters were clear and sparkling and grateful to the taste 



SANITARIANS— ANCIENT, MEDIMVAL, AND MODERN 21 

should arouse our distrust, for just such waters had been 
proved to contain the essence of contagious ailments. The 
soil, too, had become saturated with putridity; it was a 
seething volcano of disease ready to burst forth at any 
moment. The mysterious relation of disease to these airs, 
waters, and soils demanded an intercessor to negotiate the 
conditions of health between them and the people; this 
mediator should be the sanitarian ; the brokerage was to be 
paid by a draft on the public funds. 

The sanitary reformer saw, or pretended to see, the hidden 
principle of disease lurking in every operation of nature 
whereby organic substances were decomposed and their 
original elements set free to assume a new role in the uni- 
verse. The fanciful thought that certain types of diseases, 
febrile, eruptive, epidemic, and contagious, which had been 
no less fancifully named zymotic, were, in their advent and 
course, analogous to the fermentative process, was for the 
sanitarian an attractive basis for his theory ; and he went a 
step farther and called them " filth diseases." 

He made no investigation ; he relied on his riose for in- 
formation : this taught him that all of those transformations 
of matter, those reciprocal offerings of animate and inani- 
mate bodies, the cessation of which would bring disaster 
and destruction to all life on the globe, were the sources of 
zymotic and, as he called it, preventable disease. 

Herein lay the septic ferment, the morbific element ; and 
as new biological discoveries were made, which seemed to 
show that the principle of disease was a material object, a 
germ, he attempted, with a most ludicrous result, to apply 
it to his theory. He adapted to this discovery the parable 
of the sower : the filth was the soil, the germ was the seed, 
the harvest was zymotic or preventable disease. This jumble 
of fancies, words, and phrases was baptized with the name 
of Sanitary Science ; its advocates called themselves, at first, 
sanitary reformers, and later, sanitarians. 



22 VAGARIES OF SANITARY SCIENCE. 

We expect to show that there is no more proof of the 
evolution of a noxious element in the breaking up of or- 
ganic matter than there is in its creation, or in the union and 
decomposition of inorganic substances ; that in either case 
nature's analyses and nature's syntheses are equally inno- 
cent. 

To bring themselves into notice the reformers took every 
opportunity to excite and magnify the fears of the people 
about their health ; they foretold epidemics that never 
appeared ; on the other hand, epidemics broke out of which 
they gave no warning. 

Were a new convenience devised, whereby our houses 
were made more inviting and more comfortable, they cre- 
ated a new fright, and persuaded us that the improvement 
could be tolerated with safety only by the supervision of a 
health inspector. Were any method brought out to produce 
a new article of food, whereby the price of a necessity or 
luxury of Hfe could be lessened to mankind, the cry of 
danger to the public health was raised. Did some enter- 
prising man introduce a cheaper meat-supply, which implied 
the alimentation of millions, interested parties invoked the 
public health to suppress it, and found coadjutors in sani- 
tarians and boards of health to so encumber its distribution 
that the beneficent project was often defeated. Were negro 
domination in a city obnoxious, " the settled principles of 
Sanitary Science" demanded that the State Executive should 
appoint its officials, and Jacksonville's autonomy must be 
sacrificed to maintain the public health. Were an inter- 
national political crime contemplated, Sanitary Science fur- 
nished the excuse ; and our self-preservation depended on 
the seizure of Cuba as a precaution against yellow feven 

The reformers darkly hinted that there existed among us 
an unprincipled body, which to advance its interests did not 
scruple to plot against the public health, and nothing swelled 
their importance so much as the system of espionage and 



SANITARIANS— ANCIENT, MEDIEVAL, AND MODERN. 23 

secret accusation which they ordained and fostered, whereby • 
every quarrelsome man and every spiteful woman, in seeking 
revenge against a neighbor for a real or fancied grievance, 
felt secure of finding a confederate in local boards of health. 
This was carried to such an extent that their own public 
reports acknowledged from thirty to forty — private admis- 
sions sometimes made it fifty — per cent, of all complaints as 
groundless, most of them based on ill-humor. In Boston, 
in one year, sixteen hundred and thirty complaints were in- 
vestigated, in which no cause for action was found. The 
Sanitary Committee of the New York Board of Health * 
reports, " Many complaints upon investigation proved to 
have been exaggerated and in some cases to have originated 
in malice or a desire to secure personal aggrandizement." 
One city of sixteen thousand inhabitants f declared that 
many of the complaints made to its board of health were 
** the result of spite." 

Bewildered and frightened men bore all this because they 
were led to believe that the public health was in danger. 
They tried to save their wives and little ones from perils 
that existed only in the brain of the sanitarians. Power 
was conferred on these to issue decrees which they called 
" Sanitary Codes," every one of which, if we except those 
pertaining to isolation and vaccination, is useless, silly, and 
oppressive, and has no bearing whatever on public or private 
health. They told the people that if they would delegate 
to them the authority to enforce these statutes and com- 
mandments, they would be saved from epidemic disease ; 
but if they were unheeded, not the plagues and the botch 
and the emerods of the Egyptians would seize them, but 
worse. They prophesied the return of the mediaeval pes- 
tilence, — the Black Death of the Middle Ages. 

Dangers beset us at every turn ; if we stayed in the 

* 1886. f Connecticut Board of Health Report, 1SS6. 



24 VAGARIES OF SANITARY SCIENCE. 

cities, we were poisoned by sewer-gas ; it was sure death to 
go away from home ; if we ventured a visit to the country, 
the water-cooler with its impure ice was in the palace-car,* 
or it was filled from the polluted road-side well. Milk and 
cream were dairied in barn-yards ; the gases of decay from 
foul soils, cesspools, and privies were leeching into hotels 
and dwellings ; there were in-door sanitary conveniences for 
taking typhoid fever from defective water-closets, " which 
constitute at least nine-tenths of all the hotel fittings through- 
out the country, not excepting even Saratoga." There were 
out-door sanitary conveniences over pits and vaults, increas- 
ing dangers a thousand-fold to those who were subjected to 
these putrid emanations. 

What arrested the attention of observers was the facility 
with which the professors of the new-born science achieved 
celebrity. In every other department — mechanics, science, 
or art — distinction was attained only by protracted and 
patient industry and study. But in the very dawn of Sani- 
tary Science, its apostles had but to foretell some great dis- 
aster, improvise a rhapsody on cleanliness, offer an essay on 
sewer-gas, or publish a diatribe on the grinding landlord, 
and they were greeted by their fellows at the next sanitary 
convention as the Eminent Sanitarians, and henceforth 
were to enjoy the triple dignity of prophet, legislator, and 
sage. 

They found a powerful ally in the priesthood. Here was 
a body of men who were genuine lovers and promoters of 
the public weal. They were made to believe that the gen- 
eral health depended in some way on obedience to the man- 
dates of the sanitarians ; and the pulpit thundered in favor 
of sanitary reform. 

To the tender, susceptible, and prophetic female mind, 
which conceived an indissoluble tie existing between phys- 

* Sanitarian, vol. x. 



SANITARIANS—ANCIENT, MEDIEVAL, AND MODERN. 2$ 

ical purity and bodily health, the infant science offered 
peculiar charms. The sanitarians rehearsed the seductive 
tale that the sphere of woman lay in sanitary reform, and, 
after toying with it for a season, she embraced the new doc- 
trine, and by her ready pen and ready utterance has prob- 
ably done more to nurture and popularize the same than 
all the clergy and doctors put together. She was told that, 
while the more profound secrets of the dawning knowledge 
were hidden from the wise and prudent housewife, and re- 
vealed only to those who had solemnly consecrated them- 
selves to their interpretation, still she was amply competent 
to grasp the minor points and be useful to herself and fam- 
ily. She could look after the plumbing. If there were 
anything here to arouse suspicion, the alert mistress had 
in her closet an unerring test for sewer-gas in that carmin- 
ative, anti-flatulent, anti-spasmodic essence of peppermint. 
When this was poured into the pipes, if she smelled it, or 
thought she smelled it, she could rescue the household by 
telephoning the family plumber before it was too late. 
Those ladies who had a literary turn gave expression and 
vigor to the new science in their novels. Filth and sewer- 
gas as causes of disease and drainage as its preventive and 
cure were set forth in graphic story and threatened to dis- 
place altogether those finer particulars of obstetrical knowl- 
edge which had so often adorned their tales and entertained 
and instructed their readers. In Robert Ellsmere we have 
a most happy combination of both sanitary and obstetrical 
science. 

Here and there the sanitarians suborned a talented mem- 
ber of the medical profession and subsidized him to their 
uses. Though the profession at large tendered no direct 
opposition to the current of sanitary reform, and in some 
cases were persuaded as public bodies to endorse boards of 
health, many of its members looked on incredulously, and 
some of the most influential denied flatly the dictates of 
B 3 



26 VAGARIES OF SANITARY SCIENCE. 

the sanitarians respecting the origin of epidemic disease. 
As sensitive to the pubHc good as to the welfare of their 
individual patients, and trusting that perhaps there might 
be a grain of truth somewhere in this whirlwind of chaff, 
medical men yielded to the tempest of sanitary reform, and 
tolerated by their silence the charlatanry of its advocates. 
Many of them, doubtless, believed in the tradition which 
had been handed down, of the danger to health from putrid 
emanations and the decomposition of organic matter. We 
purpose to show that, in every instance where this subject 
has had a careful and systematic investigation, medical men 
have acknowledged a surrender of their prejudices. 

When it suited their interests, the sanitarians juggled 
with tables of mortality and misrepresented vital statistics. 
They stifled all investigation, all discussion. If any man 
dared, for a moment, to oppose the fury by calling for 
proof of the new doctrines, he was branded as an enemy 
of the public health. Meanwhile, by keeping the people in 
a continual ferment and panic, they established a veritable 
reign of sanitary terror.* 

The kingdom of Sanitary Science suffered violence, and 
the violent were to take it by storm. The reformers called 
for "aggressive sanitation." They demanded heavy fines 
and imprisonment for those who should transgress their 
sanitary codes. 

One eminent sanitarian f in a pubHc lecture declared 
that the causes of infectious diseases and the means of pre- 
venting them were as well known and as readily controlled 
as those of railroad dangers, and he suggests that it be en- 
acted, etc., " that every legal resident in every town in Con- 
necticut, who shall, while residing in the town, have either 
of the following diseases, viz., yellow fever, cholera, small- 



* See note at end of chapter. 

f Connecticut Board of Health Report, 



SANITARIANS— ANCIENT, MEDIEVAL, AND MODERN. 2/ 

pox, typhus fever, scarlet fever, typhoid fever, shall be enti- 
tled to receive from the treasury of the town three dollars 
for each day that he is confined to his house by such sick- 
ness ;" and that " every person so afflicted shall be subject 
to such regulations and restrictions as the board of health 
of the town shall determine." 

Another health-officer,* in Michigan, says that the world 
can never be reformed by moral suasion alone ; and, im- 
patient of the slow process of the law, he advocates a 
prompter method, and says, " If tenants whose humble 
homes have been visited by the angel of death would mob 
the landlord and throw him into the reeking cesspool, it 
would do more good than the best hygienic tract on sewer- 
gas that was ever written. If a thousand emigrants es- 
caping from a foul steamer would burn it up, it would do 
more good than an act of Congress. If the proprietor of a 
dairy distributing milk from premises where there is small- 
pox, scarlet fever, diphtheria, or typhoid fever, were set upon 
and hung on the nearest lamp-post, instead of having him 
prosecuted, this would infuse a healthy vigor into the 
makers of law." 

The sanitarians affected a deep concern for the " humble 
home," and they summoned us to behold their efforts to 
ameliorate the condition of the poor, who were at the 
mercy of the grinding landlord. This self-eulogium on the 
one hand and denunciation on the other attracted observa- 
tion and excited criticism. People asked who were these 
humane men and what had been their previous history. 
They had never before been distinguished for benevolence. 
A goodly number of them had had the sympathy of their 
neighbors for their want of success in former endeavors in 
life; others were second-class ward politicians. But with 
the help of the dilettaiiti of both sexes they organized foi 

* Sanitarian, vol. xi. 



28 VAGARIES OF SANITARY SCIENCE. 

business, and for nearly a whole generation have held the 
people on the verge of a panic, reminding them that some 
portentous calamity was impending. 

It is a suggestive and significant fact that, in order to 
avert this calamity, we were bidden to clothe the sanitarians 
with power, invest them with office, and provide them with 
money. 

Note. — A factory whicli had been in operation for forty years, and around 
which had grown up a small town whose prosperity depended on it, had suffered 
great persecution and had spent large sums of money for defence against a 
band of speculators who had invested in real estate in the vicinity, and who 
now complained of the factory as dangerous to the public health. The author 
is sure that tens of thousands (maybe fifty thousand) of dollars of expense had 
been caused this company. He asked for information and, at first, received 
an exultant reply that the company had had a costly fight, but had beaten its 
enemies, and that when the superintendent returned, who was then absent, he 
would gladly furnish the details. Not so with the wary superintendent. He 
said that it was true that his company had suffered great trouble and expense, 
extending over a period of two or three years, but he asked to be excused from 
giving any facts ; they were then on veiy good terms with the board of health 
and preferred to remain so ; that to reopen the case by publishing anything 
which had occurred might make further trouble, and they wished to let the 
matter rest. 

The author called in person on a water company which had endured a long 
and expensive contest with the health authorities on account of the pretended 
dangerous water it was supplying. A rival was in the field, and in order to 
succeed had invoked the public health. The company admitted they had 
suffered grievous wrong, but as they had won their case they did not wish to 
say anything for publication which might again stir up the matter. 

The agent of a steamship company gave the author a verbal account of the 
annoyance and expense it had been put to by a certain board of health. 
When leave was asked to publish the story, the agent showed great concern 
lest making it known should subject his company to sanitary vengeance. 

Not long ago an alarming account was given of the horrible sanitary con- 
dition of a public building in one of our large cities. Employees and visitors 
were in imminent danger every hour of being poisoned by sewer-gas. This 
condition had existed for twenty-five years. At certain seasons there are be- 
tween eight hundred and one thousand people engaged in the building during 
the entire day and sometimes part of the night. Large numbers visit it at all 
seasons of the year. The author inquired carefully of many of those em- 
ployed there if they knew or had ever heard of any sickness arising from the 



THE GREAT SANITARY AWAKENING. 29 

building. At every inquiry he was laughed at. One of the principal officials 
then told him that there was a one-hundred-thousand-dollar job in prospect, 
and he gave information to show that the whole sensation was got up by a 
ring of speculators. When leave was asked to publish these details the official 
wilted at once, and implored the author not to give them publicity; that he 
(the official) would be held up as an enemy of the public health, and it might 
cost him his position, but that if called before a proper committee he would 
state the facts. 

These are only a few instances, not to mention direct charges of blackmail, 
which the author has met with, showing that men and corporations prefer to 
suffer their wrongs in silence rather than encounter the vengeance of boards 
of health. 



CHAPTER II. 



The Great Sanitary Awakening', with an Account of 
some of the Circumstances which attended the Birth 
of Sanitary Science. 

About fifty years ago a report was made to the British 
House of Commons on the health of towns and the con- 
dition of the laboring classes in Great Britain. This docu- 
ment gave a sorrowful account of the labor, wages, food, 
clothing, and shelter of these classes. A large popula- 
tion lived in cellars ; one room frequently accommodated 
two, three, and four families. Parents with children above 
the age of puberty occupied the same bed. The lodging- 
houses were yet more crowded ; three and four adults were 
often found sleeping under the same coverlid. 

Dr. Neil Arnott * describes a portion of Edinburgh that 
he visited. " We entered a low passage like a house-door, 
which led from the street through the first house to a square 
immediately behind, which court was occupied entirely as a 
dung-receptable (with the exception of a narrow path 

* London Lancet, vol. ii., 1842-43. 



30 VAGARIES OF SANITARY SCIENCE. 

around it) of the most disgusting kind. Beyond this court 
the second passage led to a second square court, occupied 
in the same way by its dung-hill ; and from this court 
there was yet a third passage leading to a third court and 
dung-heap. There were no privies or drains there, and the 
dung-heaps received all the filth which the swarm of wretched 
inhabitants could give. The interiors and inmates corre- 
sponded to the exteriors; we saw half- dressed wretches 
crowding together in one bed to be warm, though in the 
middle of the day. Several women were imprisoned under 
one blanket, because as many others, who had on their 
backs all the articles of dress that belonged to the party, 
were then out of doors in the street." The common lodging- 
houses were resorts of the miserable of both sexes, bedded 
together promiscuously at night, " men, women, and chil- 
dren in an atmosphere odorous of gin, brimstone, and onions, 
and human miasms. Thirty and forty are often herded 
together in a couple of small rooms, four, five, and six in a 
bed ; and should one of the helpless inmates (as is often the 
case) die of typhus fever, it is by no means uncommon to 
find the identical unchanged beds occupied on the very next 
night by fresh sleepers." 

An inquiry into the manner of living of the laboring 
population in the inner ward of St. George's, Hanover 
Square, showed that one thousand four hundred and sixty- 
five families had two thousand one hundred and seventy- 
five rooms, and two thousand five hundred and ten beds ; 
nine hundred and twenty-nine families had each one room, 
and six hundred and twenty-three each only one bed. 

The Wynds of Glasgow * comprised a population of from 
fifteen thousand to thirty thousand persons. " This quarter 
consisted of a labyrinth of lanes, out of which numberless 



* General Report on Sanitary Condition of the Labor Population of Great 
Britain. 



THE GREAT SANITARY AWAKENING. 3 1 

entrances led into small, square courts with a dung-hill 
reeking in the centre. In some of these lodging-houses we 
found (at night) a whole layer of human beings littered 
along the floor, sometimes fifteen and twenty, some clothed 
and some naked ; men, women, and children, huddled pro- 
miscuously together, their bed a layer of musty straw inter- 
mixed with rags." 

Many of the houses of the poor were built around courts, 
with a pit in the middle to receive the filth of the occupants. 
" In some the whole courts up to the doors of the houses 
are covered with filth." * Their food was scanty ; meat not 
at all, or rarely once a week. There were in Liverpool 
eight thousand cellars occupied by from thirty-five thousand 
to forty thousand people out of a total of two hundred and 
fifty thousand. The working classes here numbered about 
one hundred and seventy-five thousand ; a very large pro- 
portion of these had " no means of getting rid of their filth 
but by throwing it into the street," so that " the air is con- 
stantly contaminated by the emanations from this surface 
of putrefying and offensive matter," In one cellar thirty 
people slept every night ; a hole was dug in the floor for 
the offal and filth of the household ; in another were three 
cart-loads of dung mixed with the offal from slaughter- 
houses, and ** the family in the cellar lived and slept con- 
tentedly cheek by jowl with the putrefying mass." Com- 
parisons were made of the mortality of English towns, 
showing the enormous disproportion of deaths between the 
poorer classes and the well-to-do. These tables of the 
death-rates were misleading in that they took no account 
of the birth-rate. 

The scope of those who made these inquiries and who 
furnished the reports seemed to be to show that the filth 
in some way was the cause of the disease that prevailed, 

* Sanitary Condition of Laboring Classes in England and Wales. 



32 VAGARIES OF SAXITARY SCIEXCE. 

and the medical officers appeared to comprehend it, and 
framed their answers to correspond to this aim. A very 
large majorit}' took no notice whatever of the ignorance, 
povert}', intemperance, and imprudence of these people, but 
expressed their belief that the filth in which they lived was 
the cause of the high mortality. A few, either because they 
were less obsequious, or less keenly alive to what was ex- 
pected of them, blurted out the fact that they found the 
•' dung-heap and the poison, but all the inhabitants in 
health," quaHfying the statement, it may be, with the infor- 
mation that this poison was waiting for '* a change in the 
weather or temperature," and all would be sick with " head- 
aches, constipation, small-pox, and fever; and in many cases 
atrophy." 

In Truro, fever prevailed where there was only a small 
amount of decomposition. In Kent and Sussex, filth pre- 
vailed ever}'where ; but Dr. Tuffnal states that " throughout 
the greater part of these counties comparatively few diseases 
can be found to arise from want of sanitar}- precaution." 

At Brighton were filth and overcrowding, but " the more 
seemingly unhealthy districts quote no fever." Dr. Baker 
says the cause of ill-health in Derby is the factory system 
as a whole; "because beginning with childhood, and going 
on to youth, it brings up puny parents of a puny race, who 
in their turn perpetuate and increase the evil." 

In Birmingham, the river Rea is the main sewer of the 
town ; in summer it is covered with a thick scum of offen- 
sive and decomposing matter. About fift}^ thousand of the 
people here live in narrow, ill-ventilated, filthy, badly-drained 
courts. Most of the houses are three stories high. In 
each court is an ash-pit, a pri\y, a wash-house, one or more 
pig-styes, and heaps of manure. Many of the lodging- 
houses are in a loathsome condition, crowded with beds 
occupied indiscriminately by both sexes. In the da}1:ime 
these houses are thronged with dirt^-, half-dressed women 



THE GREA T S ANITA RY A WAKENING. 3 3 

and children ; in the evening the inmates are eating, drink- 
ing, and smoking. The slaughter-houses are scattered all 
about the town, but " we do not find that any injury to the 
public health is derived from the state of the slaughter- 
houses." The knackers' yards, skinners' yards, and catgut- 
factories are extremely offensive, " but we do not find that 
these situations are more than others the seat of fevers or 
contagious disorders." Contagious fever is so rare here as 
to be almost unknown, and there is no part of the town 
where fever exists more than another. " We find it occur- 
ring in the elevated as well as in the lower situations." 

Surgeon Ryland declared bluntly that locality had nothing 
to do with typhoid fever ; that it occurred quite as much 
or more in the higher and better-drained parts of the 
town ; and that undrained houses and collections of stagnant 
water are insufficient to cause the disease. Children here 
entered the factories at as early an age as seven years. Dr. 
Howard says the amount of fever in Manchester is not 
large for a town so " peculiarly fitted to promote the dif- 
fusion of contagious disease." Indeed, he says the exemp- 
tion is remarkable, when the entire absence of cleanliness 
is considered; and he thinks that contagion is the great 
element, for the filth in some of the streets and courts that 
are exempt from disease is horrible ; large, open cesspools, 
filthy and dilapidated privies full to overflowing, " disgust- 
ing and offensive beyond conception." " Abominably filthy 
places remain free from fever for long periods ;" and he 
believes poverty and destitution are more powerful causes, 
and that something besides filth is necessary to generate 
the disease. He shows by a table that the outbreaks in 
Manchester for forty-five years have corresponded to periods 
of great distress, bad harvests, and consequent scarcity of 
food and work. He remarks, too, that when the number 
of deaths was greatest, the number of births was greatest 
also. The wages of the men in Manchester for ten years. 



34 VAGARIES OF SANITARY SCIENCE. 

ending 1841, varied from nine shillings to nine and sixpence 
per week. The wages of women and children averaged 
from five to eight shillings. Marriages were contracted 
early in life, and one witness testifies that ** few women in 
his neighborhood ever marry until they have had or are 
about to have their first infant." 

In Salop, Cheshire, and North Wales, many families have 
only one room ; here four or five and sometimes eight or 
ten people sleep. The houses abound in filth. But " not- 
withstanding the crowded and deplorable state of these 
habitations contagious diseases do not appear to have gen- 
erally prevailed." 

In Inverness the nastiness is past endurance. " There is 
not a street, lane, or approach to it, that is not disgustingly 
defiled at all times, so much so as to render the whole place 
an absolute nuisance." Fever is here, but the doctor writes, 
" For many years it has seldom been rife in its pestiferous 
influence." " The people owe this more to the kindness 
of Almighty God than to any means taken for its preven- 
tion." * No effort was made in this report to adjust these 
discrepancies of the medical officers. 

In the vast majority of cases, however, the filth was ac- 
cused as the sole generator of disease. The piercing eye 
of Dr. Barham had noticed fever connected with a " near 
proximity to even a small amount of organic matter," and 
all measures for improvement he says may be neutralized 
*' if a little nidus of morbid effluvia be allowed to remain." 
It was easy to show that the death-rate was higher among 
filthy people than elsewhere. These were generally poor, 
badly fed, clothed, and sheltered, often intemperate, and 
almost always imprudent and wasteful. They produced 
children in abundance at an early age ; these were not and 



* General Report on Sanitary Condition of the Labor Population of Great 
Britain. 



THE GREAT SANITARY AWAKENING. 35 

could not be properly cared for, and it was well that so 
many of them died. 

Mr. Chadwick showed that in some filthy and unhealthy 
districts the death-rate was sixty-eight per cent, and the 
birth-rate forty-eight per cent, higher than in some healthy 
and well-drained localities, and he ascribed the high death- 
rate only to the filthy condition of the people. The tables 
and figures which this amiable enthusiast presents must 
always be viewed with caution, for whenever they are 
analyzed they rarely sustain his conclusions. Most sur- 
prising of all is the fact that in spite of the accumulation 
of misery, poverty, and dirt, the human death-rate for three 
centuries had been steadily declining. So far as estimates 
can be depended on, says Mr. Chadwick, the deaths in 
London in 1700 were one in twenty; in 1800 they were one 
in thirty-nine. In 1799 the average age at death was twenty- 
six years; in 1830 it was twenty-nine years. All this was 
taking place long before the era of, and was not dependent 
on, sanitary reform. 

During the progress of an inquiiy * that was made by the 
metropolitan registrars into the sanitary condition of those 
portions of London which yielded high mortality rates, six, 
eight, ten, or even a dozen persons were often found sleep- 
ing in one room. The only protection from cold which 
they enjoyed was through " a few coals during the severe 
weather from the benevolent." The children were numer- 
ous ; they were herded together and " walking on the cold 
stones or sitting at the door in all weathers." With the 
adults, " spirits often supply the place of lodging, food, and 
raiment." The houses were old and filthy, occupied by 
people of " the lowest description, uneducated and foul- 
mouthed; mendicants, costermongers, thieves, and aban- 
doned females." Their " food consists of salt fish and other 

* Fifth Report of the Registrar-General of England and Wales. 



36 VAGARIES OF SANITARY SCIENCE. 

scraps collected by the mendicants and disposed of to the 
general dealers." The men spent one-third of their earn- 
ings in drink ; the women mostly indulged in gin, and stu- 
pefied themselves and their babies with paregoric. The 
mortality from zymotic disease was 6.013 P^^ 1,000,000 of 
inhabitants for cities and 3.142 for the country. The re- 
formers ascribed this difference to the filth which surrounded 
the people in the cities. They paid no attention to the facts 
that where the mortality was highest, the people suffered in 
the winter from stinging cold and from stifling heat in sum- 
mer; that the year round they endured a gnawing hunger, 
a burning thirst that alcohol itself could not quench, and 
a throbbing anxiety that nicotine and opium could not 
soothe. 

A further glance would have shown the reformers that the 
high mortality was not alone from zymotic diseases. The 
same returns which gave the proportion of zymotic diseases 
in city and country showed that the mortality from diseases 
of the nervous system was 4.267 per 1,000,000 in the cities 
and 2.256 in the country. The deaths from respiratory dis- 
eases were 7.967 per 1,000,000 in cities and 5.327 in the 
country, and the mortality from diseases of the digestive 
organs was 1.972 per 1,000,000 in the cities and 1.042 in the 
country. But the reformers only saw, or only pretended to 
see, that the drainage was defective, and that the yards, 
courts, houses, and bodies of many of these people in the 
cities were foul. Zymosis was going on, filth was created, 
and the conclusion was irresistible that this was the cause 
of zymotic, or filth diseases ; they refused to search further 
for the cause of the high mortality. 

These disclosures of the condition of great masses of the 
people in Great Britain touched the conscience and aroused 
the compassion of the English nation. For the moment no 
direct opposition was offered to the filth pathology, and with 
a great sound of trumpets it was proclaimed that good 



THE GREAT SANITARY AWAKENING. 37 

drainage and the removal of filth would exterminate that 
class of diseases known as zymotic or contagious, and the 
cry was raised for sanitary reform. 

The cemeteries received the first attention. These, both 
in London and in other towns, were in a disgusting condi- 
tion, and common decency called for a change in the care 
of them and in the method of burial. The evidence against 
them was most revolting ; but as will be shown in another 
chapter, not a single case of disease was proved to have 
originated from one of these cemeteries. 

Sanitary reform, the Lancet said, was now the order of 
the day ; we are " likely to be beset with blue-books, white- 
faced pamphlets, speechifying and figure-making, jobbery 
and intrigue ;" but the work must go on. Doctors poured 
in their reports that fever occurred under their care where 
drainage and ventilation were defective. Dr. Stark * de- 
clared there were three hundred thousand cesspools in 
London, with an aggregate exhaling surface of sixty-two 
acres ; they would make together an enormous receptacle 
ten miles in length, fifty feet in width, and six feet six inches 
in depth. In 1849 i^ was said that the public mind was 
now " on the right scent ;" the cholera was making great 
ravages and insufficient drainage was the cause ; " all 
cholera cases appear where the victims have been exposed 
to exhalations from drains, cesspools, etc." 

Associations were formed to improve the sanitary state of 
towns throughout the kingdom. If here and there a medi- 
cal man Hke Dr. Corrigan declared his belief that facts were 
in direct opposition to the new theory, he was quickly 
smothered in the ferment. In 1850 it was discovered that 
" the Thames water is polluted with every conceivable filth 
and abomination ;" the water of all the companies " is con- 
taminated with dead and living organic matter ;" and Mr. 

* Lancet, vol. ii., 1 848. 
4 



38 VAGARIES OF SANITARY SCIENCE. 

Bowie, a surgeon, testified that it " is thick, muddy, discol- 
ored, putrid, and unfit for culinary or drinking purposes." 
In a feeble way, Dr. Alfred Taylor * tried to restore a little 
calmness by affirming that if the organic matter did not 
affect the color and taste of water it was not unhealthy ; but 
in the state of the pubHc mind such reassurance was in 
vain. 

The soil, too, of London had been absorbing filth ior 
centuries ; it was nauseated with putridity ; ready to vomit 
forth disease and death ; the sewers were so constructed that 
they not only poisoned the air of the streets, but foul air 
entered through them into the houses, bringing bedrooms 
and nurseries in communication with the sewers ; the water 
was polluted, the air infected, the sunlight intercepted. 
And then it was ascertained that enormous quantities of 
diseased and half putrid meat and fish were sold, which 
generated disease. 

In 1857 1 the Thames was a vast sewer ; the most filthy and 
dangerous river in Europe ; " the stench for miles is intol- 
erable ; the moving mass of filth threatens the millions of 
inhabitants with pestilence and death ;" it was a disgrace to 
the metropolis ; a national calamity. A little later and the 
Thames was charged with sewer-gases ; " and these gases are 
admitted to be poisonous." An occasional protest was made 
against this furor. One physician hinted that the way to 
ascertain if the Thames was a source of disease was not to 
take a steamboat ride on it and toss bits of white paper into 
the water and then pronounce authoritatively from that evi- 
dence, but, by a series of observations, compare the dis- 
ease on its banks with that remote from it. This, he said, 
had not been done. Another writes that ** a little calm 
discussion was desirable ;" and " it is not proved [if it is, 
where are the proofs ?] that it [the river] acts prejudicially 

* London Lancet ^ vol. ii. f Ibid., vol. ii., 1857. 



THE GREA T SANITAR Y A WAKENING. 39 

on the health of the metropolis ;" and it was declared that 
there was " not one tittle of evidence springing from obser- 
vation" to support the conclusions that press and public 
drew from the statements respecting the impurity of the 
river. 

No heed was paid to these retorts, and the next year the 
London Lancet had a certain feeling of satisfaction in hear- 
ing that the Chancellor, Mr. Gladstone, and Mr. Cayley had 
been driven from committee-room " handkerchief to nose," 
and now " that their stomachs heave, they smell a dreadful 
smell ; their minds expand," and there is an " epidemic diar- 
rhoea of motions for relief" The editor says that many 
physicians declare that this sewage in the river is in no way 
bad for the health; and, what is still more strange, that 
some of these are men of science and known ability. The 
promulgation of such views at this time is a great error, for 
it may postpone legislation on the subject. All investi- 
gations to ascertain if the Thames had ever really been the 
cause of disease seems to have been carefully avoided ; the 
reformers, however, were unceasing in stirring up panics 
about the river. One report* says it is truly wonderful 
that some plague or epidemic has not sprung out of the 
putrescent water. The river is one vast uncovered sewer, 
reeking with noxious and pestiferous abominations, and 
that men should be found who say that this does not injure 
health must " inflict the greatest injury on science, and pro- 
duce in the mind of the public great mistrust of its pro- 
fessors." This water has been found to contain sewage, 
sulphuretted hydrogen, muscular fibre tinged with bile, 
husks of wheat, and potato cells. The danger is " imme- 
diate and imminent." Dr. Letheby declares that " the water 
is now in a high state of putrefaction ;" it " abounds with 
the highest forms of infusorial life," and that which is near 

* London Lancet, vol. ii., 185S. 



40 VAGARIES OF SANITARY SCIENCE. 

to shore is poisonous to almost every living thing but 
vibrios. 

In July, 1859, the filthy odor of the Thames warns us of 
approaching pestilence ; " its noisome stench" has reached 
the House of Commons ; much illness, and, indeed, death, 
are in Westminster, " owing most unquestionably to the 
putrid and disgraceful state of the river, aided by the intol- 
erable heat. Lord Alfred Hervey was taken sick while 
attending a committee, from the effect of the horrible state 
of the Thames." " It is truly horrible to contemplate what 
may be the result." 

Strange coincidence ! In the same volume of the Lancet 
which furnished this information we read,* " The population 
ef London now appears to be in a very healthy condition." 
" In the last two weeks deaths of persons at all ages from 
typhus and common fever decreased from forty-three to 
twenty-one ; and fatal cases of zymotic disease in the aggre- 
gate from two hundred and ninety-one to two hundred and 
fifty-three." For one or two weeks only during this season 
was there any increase in mortality, and this arose not from 
zymotic but from local and constitutional diseases. And 
the summer, as a whole, was far more healthy than the 
average. 

But all over the land it was said,t there is " one deso- 
lating germ of filth which is ever active in the fruition of dis- 
ease ; one accumulating poison, deadly alike in the cesspools 
of large cities and in the middens of country cottages." 
Typhus fever, cholera, scarlatina — the three great scourges 
of European populations — find here their nidus. 

The excitement spread like wildfire. Meetings were held 
all over the kingdom, — in halls, school-houses, and drawing- 
rooms, — presided over by noblemen of distinguished lineage. 
A Ladies' National Sanitary Association for the Diffusion 

* June 19, 1858. f London Lancet, 



THE GREAT SANITARY AWAKENING, 4 1 

of Sanitary Knowledge was formed in London, with branches 
in different towns. This had for patrons and patronesses 
crown princes and princesses, dukes and duchesses, earls 
and countesses, bishops, right honorable and honorable, 
and distinguished men of the learned professions and promi- 
nent laymen, with a long list of secretaries and committees. 
The society's report for 1861 said there had been already 
spread over the country 138,500 sanitary tracts, 10,000 on 
" The Cheap Doctor," 8000 on " The Sick Child's Cry," and 
8000 on " Never Despair." Sanitary classes were formed; 
lectures were delivered on catching cold, on drainage, food, 
air, clothing, etc. 

The ladies put their sanitary reason into sanitary rhyme, 
and " Never Despair" found expression in these lines : 

** When times are hard and money scarce 
And you are full of care, 
There's one thing you must never do, 
You never must despair. 

" It makes the spirit faint and fail. 
It wears the health away ; 
It takes all vigor from the heart 
And wastes life day by day." 

To illustrate the danger of filth we have the following 
stanzas : 

" If things get worse and worse within, 
And heaps of filth and rubbish lie 
Fermenting, steaming at your very doors, 

How can you wonder that your children die ? 

" Work till you've cleaned within, without. 
And done your duty, done your best ; 
Then may you claim it as a right 
Your landlord he must do the rest." 



Instructions for the baby were given as follows : 

4* 



42 VAGARIES OF SANITARY SCIENCE, 

" When baby ought to eat, 

He'll have some teeth to bite, 
And if he must have any food, 
Be sure it's soft and light." 

Tight lacing was treated in this way : 

" Now if you press the body round, 
The soft bones soon give place, 
And then the lungs can't freely breathe. 
Nor the heart have full space. 

" Proud thoughts, high looks, and selfish ways. 
Words that give others pain, — 
These things we all should by God's help 
Incessantly restrain." 

In a sanitary ditty on " Naughtiness and Sickness" the 
greedy boy is admonished that, — 

** The greedy and the gluttonous 
Get sick and can't enjoy 
What would have been quite nice and good 
Shared with another boy." 

These hygienic idyls seemed to have charmed the people. 
One essayist on woman's work in sanitary reform said that 
these tracts in verse were " very suitable for reading aloud 
at Maternal Meetings ;" and he called on female writers to 
" make imaginative literature a vehicle of popular sanitary 
instruction ;" to tell us why preventable disease and death 
forever sit scattering our hopes and joys and holding a 
grim carnival among our loved ones." " Let us have," 
he cried, "a sanitary Jane Eyre, Adam Bede, and John 
Halifax." 

One physician writes, " You ladies will do a good work, 
if you only bring us medical men to lecture to the people. 
But we cannot put ourselves forward. If your association 
were only to do this, you would do a good work." 

Mothers' meetings were called ; tea meetings were held, 



THE GREAT SANITARY AWAKENING. 43 

to which " Bible women" were invited ; missionaries were 
sent out ; these were supplied with brooms and brushes to 
lend to the poor, and a special fund was set apart to supply- 
skipping-ropes, balls, and toys to poor children. By Janu- 
ary, 1865, the Ladies' Association had sent out more than 
seven hundred thousand tracts, " a moral force that implies 
vast extension of sanitary information." * 

Out of such fury and tumult, and with the aid of such 
hysterical throes, the world witnessed the birth of Sanitary 
Science. The infant came near being suffocated in the trav- 
ail by the very ladies who had assisted at the accouche- 
ment ; for, in arranging one of the lecture courses, a 
" homoeopath" had either crept in or had been smuggled in 
by the ladies as one of the speakers. This caused a great 
commotion ; the Lancet scolded them soundly. It told 
them they could not have taken a surer course to throw 
doubt on their ability to conduct or even understand Sani- 
tary Science ; and added, " In their innocence they may 
imagine the sanitary conduct of a homoeopath would be the 
same as that of a medical practitioner of any other school ; 
but this is an error." It protested against the associa- 
tion lending itself to the propagation of miserable fancies. 
History is silent as to the result of this contest. Our own 
experience and observation have been that, whenever the 
ladies take it into their heads to boom a homoeopath or any 
other doctor they never fail to succeed. 

The prince consort died in December, 1861, of typhoid 
fever. Windsor Castle was, in the opinion of the best engi- 
neers, the most complete in sanitary works of any large 
building in the world. The pythogenic nature of this fever 
was now established in the minds of the reformers, and if 
nothing were found to account for the prince's illness the 
doctrine was in danger. Finally some witnesses were pro- 

^ Report of Ladies' Sanitary Protective Association, 1S65. 



44 VAGARIES OF SANITARY SCIENCE. 

duced who testified that they actually had smelled some smells 
somewhere about Windsor Castle, though why the prince 
consort should be the only one taken sick the sanitary re- 
formers did not explain. They publicly exchanged con- 
gratulations, however, that the prince's illness and death had 
given a great impulse to Sanitary Science, and that the 
towns generally were sounding the alarm. 

A few medical men made one more attempt to stem the 
torrent of nonsense. They called for calm investigation, for 
proof; they said the new doctrine was inconsistent with 
facts. They were, for the most part, overwhelmed, and 
were only too glad to be silent after being pilloried in the 
Lancet. They knew too well to whom the editor was point- 
ing when he wrote that " people are yet found who literally 
wallow like unclean animals in their own filth and protest 
that it is wholesome. They foul their water sources, drink 
with gusto the sparkling fluid, and vow there is no water to 
be compared with it. By these means children are cut ofif 
by thousands ; adolescents grow up with the seeds of de- 
bility and disease ; adults are struck down in their prime ; 
the sum of life is shortened ; the productive and protective 
powers of the country are diminished." 

In 1867 the Thames water had great quantities of putres- 
cent animal matter on account of the late rains, and in the 
city " the pumps are spouting poison." Meantime, all sorts 
of patent sanitary fittings were advertised in the Lancet, — 
patent stack- pipe water-closet ventilators, filters to filter the 
water, smoke-stacks for sewer-gas, — all warranted sure pre- 
ventives of disease. Every new fright brought out new 
patents. 

The Lancet was very angry because Dr. Letheby had 
proved that the water-supply had nothing to do with the 
cholera of 1866; there were some slight symptoms of reac- 
tion, for people were beginning even to lose faith in the 
legend of the Broad Street pump. The analyses of the 



THE GREAT SANITARY AWAKENING. 45 

same waters by different chemists showed entirely different 
results, and all was bewilderment and confusion. Even the 
water from the chalk-wells showed contamination, and the 
cry was now raised that there were fissures in the chalk for- 
mation that allowed the ingress of sewage. 

The Lancet recorded the " spread of infectious diseases, of 
holocausts of infant life, of death-rates shockingly exces- 
sive." " How is it that this death-page of our national his- 
tory yet remains where it was years ago when our scientific 
knowledge was less ?" Severer laws must be enacted to 
save the people. 

Fever was reported at Barnsley; a cesspool was found 
here within a dozen yards of a pump, and the Lancet says, 
" There does not seem to have been any attempt to ascertain 
whether the inhabitants of the district were or were not 
systematically drinking the discharges from one another's 
bowels." 

There certainly seems to have been no attempt made to 
show that this condition had prevailed, it may be for a cen- 
tury, without producing fever in Barnsley. 

The Prince of Wales's illness with typhoid fever now 
gave another impetus to sanitary reform. The cause could 
not be ascertained any better than that of his father's sick- 
ness ten years before. It was discovered that at Londes- 
borough Lodge, where the royal party was located, a water- 
closet, which had free ventilation with the outside air by an 
open window, was close to the prince's bedroom ; but the 
British Medical and Surgical Journal said that this was the 
case in thousands of instances in London, yet no fever was 
the result. It was then found out that the prince was in the 
habit of riding by some carrion that was exposed to allure 
the pheasants ; also it was proved that he had actually 
passed by a pile of manure which had painfully affected the 
nose of His Grace the Duke of Beaufort. Though the 
Lancet was reluctant to believe that the constitution of the 



46 VAGARIES OF SANITARY SCIENCE. 

heir to the British throne was so feeble as to collapse under 
so simple a matter as a bad smell from a manure-heap, yet 
in some one of these various ways he must have contracted 
the fever, because it was conceded by the most eminent 
sanitarians that this was the type of filth diseases. 

Every new alarm that was invented was heralded as a 
"gigantic stride" of Sanitary Science. In 1875 the sanitary 
aspects of the sacraments were discussed ; there was danger 
of contagion in the communion wine-cup. Again, blood- 
poisoning had been caused by Hcking gummed envelopes, 
and there was disease and death in the books of the circu- 
lating libraries. Dr. Farr now fulminated against the Thames 
water; it was loaded with filth. Dr. Letheby declared the 
alarm unnecessary, and the Lancet pronounced this contra- 
diction " a scandal in the scientific world," and insisted that it 
was time that the richest city on the globe should know the 
truth about its water. 

The Lancet said, " The demon filth which surrounds and 
poisons us on all sides is not to be exorcised by gentle lan- 
guage. No words which society will permit us to use are 
too coarse to hurl at the monster. It is not pleasant to 
drink the diluted excreta of men or even of pigs ; but it is 
still worse to drink the ^^^?> or germs of cholera or typhoid 
fever." 

When the fever broke out at Wolverhampton and some- 
body suggested contamination of the water and that it be 
examined, he was withered by the reply that it was "a 
waste of time to analyze such water ; of course it was con- 
taminated." "A moment's thought" of the foul soakage 
was sufficient to indicate its character. 

The epidemic in Croydon in i Z'j^y staggered the sanita- 
rians for a moment in their filth-theory of disease. Croydon 
had had for twenty-five years all the advantages of efficient 
sewerage, good water, and good sanitary administration, yet 
in twelve months there were twelve hundred cases of ty- 



THE GREAT SANITARY AWAKENING. 47 

phoid fever in the town, and " this seemed to render doubt- 
ful some of the fundamental principles upon which sanitary- 
measures are founded." But the reformers soon rallied; 
the old theme was revived, and in 1880 the Thames was again 
a putrescent pond and a fermenting sewer, menacing the 
people with disease and death. One memorial made to the 
Lord Mayor on the stench of the river recited that a man 
fell into it a few days before and was found dead, although 
he had been in the water only two minutes, " having been 
actually poisoned by the deadly properties of the water." 
The Thames through London is more and more polluted ; * 
it is no better than a common sewer. No one can go to 
London from Woolwich with comfort. There is a disgrace- 
ful system of house-drainage in the best parts of London. 
Sewer-gas is a special product of our refined system of 
sewerage. " We have now a perfect apparatus for treasuring 
it up and laying it on in our houses." Disinfectants are of 
no use ; they are only disguisers. Poisoning by sewer-gas 
which has been deprived of its smell is the source of much 
sickness ; the odor may be destroyed, but the poison re- 
mains. 

In 1884 1 the condition of the Thames was as bad as it 
could be ; "a deadly, insidious odor arises in the form of 
sewer-gas," polluting air and water for miles. The river 
" can only be compared to a huge sewer-tank, putrescent 
and most offensive. We are living in extreme risk." " It is 
literally dangerous to breathe the air," and there was a con- 
tinual wrangle over the conflicting analyses of the water ; 
and so on to 1890, October 25, when we read in the Lan- 
cet that the progress of sanitation and increase of typhoid 
fever in India was an anomaly ; but trust in the filth pathology 
was unshaken. 

The florists of Liverpool were now deeply stirred about 

* Builder^ 1881. f London Lancet, vol. ii. 



48 VAGARIES OF SANITARY SCIENCE. 

the public health ; they implored the mayor to place restric- 
tions on the hawkers of flowers in the streets, for many of 
them lived where infectious diseases prevailed. For once 
the Lancet was incredulous, for it said " the exhalations from 
some flowers are antiseptic," and it hinted that " the dread 
of competition" in the minds of the florists excited " their 
zeal for hygienic purity." 

If the reader thinks this is a travesty on the rise and 
progress of Sanitary Science, let him be assured that the 
story is taken, not from the wild ravings of irresponsible 
newspapers, but for the most part from the pages of the 
most influential journals that were printed in Great Britain 
between the years 1845 and 1 891. In all of this sanitary 
inebriety there is no trace of scientific research. If an Eng- 
lish physician questioned the filth pathology of epidemic 
disease, and suggested an investigation, he was quickly si- 
lenced by the ribaldry of the London Lancet. Scotch and 
Irish medical men, like Christison, Hughes Bennett, Stokes, 
and Graves, maintained a point-blank denial to the new doc- 
trine ; they declared that it was antagonistic to the facts. 

The stubborn truth faces us all through these forty-five 
years that, while the people in England were breathing this 
pestilential air, drinking this polluted water, living on this 
contaminated soil, eating this diseased and putrid meat and 
fish, the death-rate was not increased, but, on the whole, was 
steadily diminishing, as it had done for three hundred years 
before the dawn of Sanitary Science. 

The birth of Sanitary Science in America was not pre- 
ceded by the tedious, irritable, and painful gestation which 
heralded its advent in England. Indeed, the infant science 
can hardly be said to have had an embryotic existence in 
this country, for it was greedily accepted as it came forth 
from the hands of the English reformers, by a set of men 
here who soon found that by ingeniously exploiting its 
vagaries they could attain to an importance and acquire a 



THE GREA T SANITAR Y A WAKENING. 49 

position and emolument that had heretofore been denied 
them both in the community and in the medical profession. 
What the American sanitarian lacked in originality was 
amply compensated to him by the faculties of imitation and 
volubility of expression ; and, as will be seen later, as whim 
and chimera one after another were hatched in and launched 
from the brain of the English reformer, they were seized at 
once by his American copyist, without examination or in- 
vestigation, and were appropriated and published by him 
without delay as the " settled principles of Sanitary Science." 
The excitement began soon after the close of the Civil 
War, and by 1870 had reached a kind of frenzy. Whole 
sections were deeply moved by the elocution of the re- 
formers. Sanitary surveys and inspections were made which 
showed that towns and cities, great and small, were on the 
brink of a dreadful precipice ; their inhabitants were located 
on a filthy soil, were enveloped in foul air, and were drink- 
ing foul water. Sanitary conventions were held, sanitary 
platforms were erected, on which the sanitary orator mounted, 
and, with flaming eye, declaimed to his quaking audience 
that the conditions under which they were living invited the 
direst of all pestilences, — the Black Death of the Middle 
Ages. Strong men were aroused to action, and were re- 
solved to save themselves and their families, if possible, 
from the perils which environed them, on account of the 
pestilential, polluted, contaminated air, water, and soil. 



50 VAGARIES OF SANITARY SCIENCE. 

CHAPTER III. 
The Air. 

" There are indeed two things ; knowledge and opinion ; of which the one 
makes its possessor really to know, the other to be ignorant." — Hippocrates. 

To avoid all cavil and misconception, let us premise this 
chapter with a disclaimer of any desire or intent to disquiet 
the prejudices of enlightened mankind in respect to cleanli- 
ness. That purity of body is a necessary accompaniment 
of purity of mind and morals needs no argument to sustain. 
Indeed, this proposition loses its force in proportion as any 
labored reasoning is obtruded to support it. As a corollary, 
this other proposition may attend the previous one, — to wit, 
that a clean body and clean surroundings, — pure air, pure 
water, and pure soil, — in so far as they add to the comfort, 
decency, and dignity of the human family, are not only 
accessories but essentials as well to individual as to public 
health. In reality, the amiable delusion that a want of 
cleanliness was the cause, or one of the causes, of infectious 
disease might have been allowed to remain, for it was harm- 
less, except as the violence of the sanitary reformers forced 
it upon us, to the exclusion of all other causes, and com- 
pelled us to examine critically the evidence with which they 
upheld it. 

The " opinion," the belief, that decomposing organic 
matter, animal and vegetable, by contaminating the air, is 
the prime factor in the production of certain diseases, nota- 
bly epidemic and contagious, has always possessed not only 
the popular mind, but also to a great extent that of medical 
men who have given the subject no investigation. 

Organic matter in decomposition evolves certain gases ; 
but no one claims, and every one who has examined the 



THE AIR. 51 

subject with care will deny, that any single known gas or 
any known combination of the gases of putridity is capable 
of causing disease. Some of them, in a concentrated form 
or by displacing the oxygen of the atmosphere, cause 
asphyxia and death. But no known element which is ex- 
haled in the breaking up of organic compounds is any more 
capable of generating disease than any which is given off in 
the decomposition of inorganic bodies. 

So it was left for the sanitarian to imagine a something 
which he called sometimes a " septic ferment," sometimes a 
" morbific element," sometimes a " subtle poison," sometimes 
the " mephitic gases," and later this something was desig- 
nated by the Massachusetts Board of Health as the " un- 
known factor." Not content with these definitions, the sani- 
tarians, as we shall see, made use of symbols which, to the 
popular mind, expressed the highest degree of terror. The 
hidden principle of disease which was given off in putrefac- 
tion was represented sometimes in words, sometimes in 
figures, as " a demon," " an unclean spirit," " a monster," 
" a snake," " an unseen vampire." 

It was plain to every observer that huge masses of organic 
substances were continually in process of decay, giving off 
sometimes the most offensive gases, yet no infectious disease 
was present. On the other hand, infectious diseases often 
invaded a family and a neighborhood when no visible de- 
composition of organic matter was in progress. 

According to the sanitarians, it was this imaginary ele- 
ment that was developed in filth which caused the mediaeval 
pestilences that devastated Europe, and which they predicted 
would surely return to us unless we gave heed to their 
warnings. A large number of the writers on hygiene 
approve, to greater or less extent, this theory of infectious 
disease, and it has always been the sole stock in trade of 
modern boards of health. 

John Howard, in his book on prisons, says Dr. Hales and 



52 VAGARIES OF SANITARY SCIENCE. 

Sir John Pringle observed " that air corrupted and putrefied 
is of such a subtle and powerful nature as to rot and dissolve 
heart of oak." 

Bancroft * says Lord Bacon thought that no effluvia were 
so infectious and so pernicious to mankind as those which 
issued from putrefying human bodies. Fonssagives f says 
the " morbific principle" that proceeds from decomposing 
animal matters can produce the gravest maladies. Thus, he 
says, bursts out a pestilence after a battle, and the decom- 
position of matters in privies causes dreadful septicaemia. 

Tardieu % says that the centres from which putrid emana- 
tions are disengaged are the types of unhealthfulness. This 
can hardly be otherwise, for it is not only by their composi- 
tion {nature intime) that they act, they strike the senses, 
and produce on the most delicate organs " une impression 
penible'' which seems the announcement of a real danger. 
Galen, he says, assigns the cause of pestilential fevers to 
putrid air from bodies left on battle-fields, and St. Augustine 
reports a cruel pestilence caused by masses of decayed 
locusts. Tardieu relates a number of similar antiquated 
stories to prove the noxious character of putrid emanations ; 
but when he discusses certain trades, like tanners, curriers, 
catgut-makers, etc., he says that though they are foci of dis- 
agreeable odors, they are not unhealthy; and when he 
treats of voiries, although these contain everything conceiv- 
able that is foul, he declares they not only do no harm, but 
he has known them to re-establish health that has been 
impaired. 

All of the noisy and influential EngHsh sanitarians have 
persuaded themselves that filth is the great cause of con- 
tagious disease. In the reports of the medical officer of the 
Privy Council, London, 1874, is a recital of forty-two in- 

* Yellow Fever. f Hygiene Navale. 

% Dictionnaire d'Hygidne, article ** Emanations Putrides." 



THE AIR, 53 

spections of towns where occurred in 1873 outbreaks of 
small-pox, scarlatina, typhus and typhoid fevers, and diar- 
rhoea, which are ascribed to polluted water and accumula- 
tions of filth. The reports are not complete, inasmuch as 
they do not state how long these towns had been exposed 
to these conditions and had been free from such diseases. 
In 1874 Dr. John Simon published "Filth Diseases and 
their Prevention." He ascribes the disease-producing power 
of filth, not to any known gases which may arise from it, 
nor to the fact that it is disagreeable to the senses, but to a 
" septic ferment" which, he says, is generated in filth. The dis- 
eases caused by this " septic ferment" are diarrhoea, enteric 
fever, cholera, erysipelas, pysemia, and diphtheria. He gives 
a short account of one hundred and forty-three outbreaks 
between 1869 and 1873, where privies, cesspools, and defec- 
tive drains were discovered, though he does not state in 
what particular the sanitary condition of the afflicted towns 
differed from all others in Great Britain where no epidemics 
occurred. 

Parkes, in his elaborate work on hygiene, though he gives 
numerous examples where disease has been imputed to foul 
air, water, or soil, is careful not to commit himself to the 
filth-theory of disease, and makes no allusion to the " septic 
ferment," which Mr. Simon considers the generator of infec- 
tious disorders. 

Miss Florence Nightingale, in her work on nursing, says, 
" I was brought up, both by scientific men and ignorant 
women, distinctly to believe that small-pox, for instance, 
was a thing of which there was once a first specimen in the 
world which went on propagating itself Since then I have 
seen with my eyes and smelt with my nose small-pox 
growing up in first specimens, either in close rooms or in 
crowded wards, when it could not have been by any possi- 
bility caught, but must have begun. Nay more, I have seen 
diseases begin, grow up, and pass into one another. I have 

5* 



54 VAGARIES OF SANITARY SCIENCE. 

seen, for instance, with a little overcrowding, continued fever 
grow up ; and with a little more, typhoid fever ; and with a 
little more, t}^phus ; and all in the same ward or tent. Dry- 
dirt is comparatively safe dirt ; wet dirt becomes dangerous. 
Uncleansed towns have been made pestilential by having a 
water-supply." 

In our own country the filth theory of disease has taken 
deep root with the sanitarians. Hardly an epidemic has 
occurred anywhere in this country which their official 
reports have not loosely ascribed to filth. If an ancient 
cesspool, a profligate privy, a suspicious well, an untrapped 
sink, or the contents of a dish-pan on the surface of the 
ground could be found anywhere in the vicinity of an epi- 
demic it sufficed to explain its origin, although the same 
condition might prevail in millions of cases where no sick- 
ness occurred. 

In the Sanitarian, April, 1878, a lady writes that dirty 
dish-cloths are a cause of typhoid fever ; she had smelled a 
whole houseful of typhoid in one dish-rag; she is sure it 
caused four cases in one family where she " ran in" to assist. 

In " Home and Health : A Cyclopaedia of Facts," by C. H. 
Fowler, D.D., LL.D., and W. H. DePuy, A.M., D.D., article 
" Fever Infections," we are told that all fevers, like typhus, 
small-pox, etc., arise from a subtle poison. " This poison 
has been actually condensed out of impure air poisoned by 
filth and decay, and appears in the form of a dirty-looking, 
half-solid, half-fluid, half-gelatinous stuff, a few drops of 
which inserted into the veins of a dog will inoculate that 
dog with typhus fever." 

Mr. Waring * says that as to the exact causes of disease 
we know comparatively little, but there are certain well- 
established truths. " One of these is that man cannot live 
in an atmosphere that is tainted by exhalations from putre- 

* On Sanitary Drainage, etc. 



THE AIR. 55 

fylng organic matter without danger of being made sick, — 
sick unto death." Professor S. W. Johnson says the filth 
of vaults and cesspools " may long remain simply disagree- 
able without being dangerous, and may again of a sudden, 
in a way whose details have as yet escaped our observation 
[italics ours], become the seed-bed or the nursery of the 
infection that breaks out in fevers and dysentery." " Clean- 
liness," says Professor Lindsley,* " public cleanliness, is the 
highest aspiration of the public hygienist. Filth in any 
form is the fatal foe of human life,— a foe unsparing, insid- 
ious, unceasing, mahgnant, and deadly." "Already," he 
cries, " the city of New Haven has had to erect a special 
police prison in its most unsanitary ward. Cleanliness is 
the grand aim of the sanitarian's efforts." 

Says a distinguished sanitarian,t " We thus see that all 
the great epidemics of mankind originate in filth and are 
propagated by filth. Of all the forms of filth, none are more 
active than the direct and indirect products of animal life. 
Man is a poisonous animal; his touch brings rottenness. 
Human filth is the hot-bed of epidemic disease." As a 
breath fans the fire, " so the fever-germ may be carried a 
long distance and, falling into some magazine of unsanita- 
tion, may explode into a frightful epidemic." " These fever- 
nests seem to attract the wandering epidemic germ, just as 
the depot of nitro-glycerine seems to fascinate the fool- 
hardy hand which shall wake up this bottled earthquake." 

" Does death end all ?" he asks. " Certainly not. There 
remains the funeral. What is the funeral of the yellow- 
fever dead ? As soon as death is certain, the body, in all its 
filth and with the garments it last wore, still warm with the 
remains of life, is seized by some hired grave-digger, thrust 
into a coffin, hurried into some cart, and toted off to the 



* Connecticut Board of Health, 1883. 

f Eighth Report Michigan Board of Health. 



56 VAGARIES OF SANITARY SCIENCE. 

graveyard ; and, when its turn comes, it is dumped into its 
grave and covered from sight forever. ' Mud to mud' would 
close the fitting burial service. Death is terrible; such a 
death and burial are horrible." 

Another distinguished sanitarian,* when discoursing on 
decomposing organic matter, says, " It is perfectly safe to 
say that a foul-smelling air is a dangerous air. Every now 
and then Death makes a visit to the household, carrying off 
its brightest members, ruthlessly slaying father, brother, 
sister ; the strong man, the feeble infant. Why this sacrifice, 
— this ruthless slaughter? Who are the invisible monsters 
invading this happy circle ?" " Let us look around," he says. 
Smell informs him that there are decaying vegetables in the 
cellar, " pouring forth into the air deadly emanations ;" this 
" stagnant, poison-laden air" finds its way into the lungs of 
the occupants of the house. " We ascend to the kitchen ;" 
here are what every one recognizes as " kitchen-smells." In 
one corner is the wood-box. Turn the contents on the 
floor, and, "shade of Hygeia, what a smell !" Rotten bark, 
apple-cores, odds and ends," making " a putrescent con- 
glomeration teeming with filth, redolent with putrefaction, 
and crawling with vermin." In the pantry are fragments 
of mouldy bread, " a magnificent place for germs of every 
description to hold high carnival." The beautiful carpet in 
the sitting-room "conceals beneath its delicate shades a 
conglomerate accumulation of contributions from every 
source of impurity within the dwelling and without." The 
parlor is still worse. Above are closets, chambers, and 
garret, "charged with the most virulent enemies to health." 
In the yard myriads of insects are crawling where the dish- 
pan has been emptied. "A few feet distant is an edifice 
which we are at a loss to know how to describe ;" but the air 
from it " is freighted with the agencies of death." Then there 

* Tenth Report Michigan Board of Health. 



THE AIR. 57 

is the well. " Only think of the condition of a family with 
death enthroned in the well and daily dealing out his poi- 
sonous draughts to its members !" " Some one may say the 
picture is highly colored ; but the experienced sanitarian 
will certainly say we have not told half the truth." If we 
only had microscopic eyes we should see in many of these 
houses " not an army of brave soldiers coming to our rescue 
from disease and death, but the emissaries of death in 
countless numbers, intent upon our destruction, ready to 
pounce down upon us at the first favorable opportunity, rack 
us with pain, and finally devour us." This " experienced sani- 
tarian" does not say whether he is describing his own resi- 
dence or the typical Michigan habitation. 

Nothing short of these liberal quotations could possibly 
illustrate the native grandiloquence of our sanitarians. Lest 
the reader shall exclaim that this is a parody on Sanitary 
Science, and that we have here introduced the insane ravings 
of some backwoods revivalist on the terrors of the judgment 
day to an audience temporarily bereft of reason and powers 
of comparison, we here affirm that these were the declara- 
tions of eminent sanitarians who have the prefix of professor 
and the affix of M.D. to their names ; that they were ad- 
dressed to bodies of sanitarians in convention assembled, 
and that the subject of the discourses was Sanitary Science. 

In all of this improvisation — and sanitary literature every- 
where is overflowing with similar harangues — there is not a 
particle of evidence to sustain the filth-theory of disease, 
except such as is offered by the field-of-battle story of Galen, 
the locust story of St. Augustine, mentioned by Tardieu, the 
positive testimony of Miss Nightingale's eyes and nose, and 
the no less positive evidence of the lady respecting the dish- 
rag origin of typhoid fever. 

It would be unbecoming in us to deny the direct testi- 
mony of the two Doctors of Divinity in the " Cyclopaedia 
of Facts," regarding the " subtle poison" of fever which 



58 VAGARIES OF SANITARY SCIENCE. 

they so minutely describe as '' dirty-looking-, half solid, half 
fluid, half gelatinous," and which must have been seen by 
them alone ; for it is mentioned nowhere else than in their 
book, and, so far as we have inquired, it is not to be found 
in any of the chemical or biological laboratories. 

The remaining proof which sanitarians have to offer con- 
cerning the noxious character of putrid emanations lies 
only in the occasional coexistence of these and disease. 
There is no more scientific proof that putrid emanations 
cause infectious disease than that they are the sources of 
acute or even chronic inflammatory complaints ; and it needs 
only a little higher flight of sanitary imagination to pro- 
nounce the latter filth-diseases, because they happen in a 
neighborhood where a cesspool, or privy, or drain may be 
found. 

The " opinion" of many of the most thoughtful medical 
men has been often expressed, that this coexistence of 
putridity — filth — with disease has not the relation of cause 
and effect. The author has been unable to find a single 
instance, where this subject was scientifically investigated, in 
which the proof was not overwhelming that organic matter 
in any of its chemical changes was incapable of producing 
epidemic disease. 

Dr. Ferguson says, " It is, in truth, unnecessary to mul- 
tiply facts and illustrations to prove that putrefaction and 
the matter of disease are altogether distinct and independent 
elements; and that, however frequently they may be found 
in company, they have no necessary connection." 

Dr. Chisholm,* in an article on contagion, after enumer- 
ating whole tribes and nations who maintain their health in 
the presence of the worst putridity, cites the towns of Bris- 
tol, Bermondsey, Conham, and Bitton. In these cities, bone- 
boiling, glue-making, fat-rendering, and tanning are going 

* Edinburgh Medical and Surgical Journal, vol. vi. 



THE AIR. 59 

on, which fill the atmosphere for a mile around with a dis- 
gusting fetor. In Bristol the streets are narrow, the houses 
crowded and ill-ventilated ; yet the harmless nature of these 
exhalations is daily verified. Neither the workmen nor the 
inhabitants are made sick ; the reverse is the fact ; they are 
the most healthy of any of the laboring poor. After a care- 
ful survey, Dr. Chisholm, who almost apologizes for saying 
so, concludes that the theories of ingenious chemists re- 
garding the power of animal efifiuvia to produce disease 
receive no support from practical knowledge or the econ- 
omy of nature. 

Dr. Nathaniel Bancroft * says, " I have no desire to 
weaken any of the prejudices which tend to promote clean- 
liness in civilized countries, any further than is absolutely 
necessary for the manifestation of truth on a question of 
great importance to mankind ;" but he declares that there 
is no connection between offensive smell and nastiness and 
contagious fever. That putrefaction, which is but a natural 
separation of organized matter, is the servant of chemical 
attraction, and the products are as certain and constant as 
the combination of soda with muriatic acid. 

Dr. Graves f says, " The causes of epidemic disease es- 
cape the scrutiny of both nostrils and vision. Filth is the 
outward and visible sign of poverty, and, like poverty, is 
itself an evil ; it oftener accompanies than causes disease." 

Dr. Stokes quotes the report of a sanitary inspector of 
an Irish town of four thousand inhabitants. Every part 
" was teeming with effluvia from such decayed substances 
as are admitted to be of the most noxious kind, but this 
town has always been a remarkably healthy place." Dr. 
Pratt declares that if fever were caused by decomposition 
of animal and vegetable matters, Ireland would have been 
depopulated long ere this from sea to sea. He gives this 

* Yellow Fever. ■}• Dublin Quarterly^ vol. vi. 



60 VAGARIES OF SANITARY SCIENCE. 

opinion on the experience of twenty-five years' practice of 
an Irish dispensary officer among the agricultural classes, 
where the house-yards are often heaped up to the very door 
with manure, and are the receptacles of slops and refuse of 
all sorts, which ferment and " produce a green and stagnant 
pool," where gases are generated which burst on the sur- 
face. Dr. Pratt says, " In such places a case of fever of 
any type rarely occurs, the average length of life is as high 
as elsewhere, and illness except common colds is almost 
unknown." Dr. Stokes says, in his lecture on public health, 
" There is no proof that dirt ever in itself caused a case of 
specific disease. The real antagonistics to any successful pre- 
ventive medicine are poverty, destitution, ignorance, apathy, 
insufficient and improper food, filthy habits, overcrowding, 
bad ventilation, insufficient clothing, the living in ruined and 
neglected tenements, the destruction of proper pride and the 
blessed influence of home." 

Dr. J. C. Warren * made a thorough study of the influ- 
ence of putrefaction in the production of disease. The 
workmen in those trades most exposed to putridity were 
most exempt from infectious disorders. He says the whaling- 
vessels are saturated with putrid animal matter, in hot as 
well as cold climates ; the odor is sometimes intolerable to 
those not habituated to it ; but the seamen on these ships 
are more healthy than those engaged in any other ser- 
vice. 

Dr. Davis f records his studies of the influence of occu- 
pation on health. He found that the health of brewers, 
distillers, tanners, curriers, glue-makers, tallow-chandlers, 
soap-makers, of all of those, in fact, who were exposed to 
putridity in its worst forms, was never impaired by these 
occupations, and though the stench from glue-making is a 
nuisance to the entire neighborhood, " many assert that on 

* Boston Medical and Surgical Journal, 1829. f Ibid., 1833. 



THE AIR. 61 

entering this employment they experience a marked increase 
of appetite and health." Notwithstanding that those who 
are engaged in tanning are exposed to masses of putridity, 
dampness, and dust, experience has shown that this trade 
is a benefit to consumptives. 

One of the most searching investigations of the influence 
of putridity on health was made by Parent Duchatelet in 
1832.* This distinguished hygienist was guided in all of 
his inquiries by the love of truth. Unlike the sanitarian 
of a later day, he sought neither to exalt himself nor to in- 
crease his revenue by exciting a panic in the public mind. 
If an imaginary danger appeared, he strove to allay the 
fears of his fellow-citizens. The village of Montfaucon was 
just outside of Paris. Here was the depot for all of the 
refuse and fecal matter of the great city, and here the faeces 
were converted into poudrette. Here were also bone-boil- 
ing, glue-factories, and the rendering of dead and diseased 
animals. Very often the authorities were appealed to for 
their suppression on the ground of danger to the public 
health. When the cholera was approaching Paris in 1832 
these petitions increased, signed largely by medical men, 
who represented that if Montfaucon did no harm in ordi- 
nary times, it was only waiting for the spark of an epidemic 
to explode in pestilence ; that localities like this invited the 
disease; that here it would centre and diffuse itself over 
the country. Parent was appointed to investigate and re- 
port. He says the odor here was " insufferable, indescrib- 
able, insupportable." But if we interrogate the workmen, 
they, without exception, answer that, far from being nox- 
ious, these odors are beneficial to their health (" contribucnt 
a leur bonne sante'). Parent says that in every direction 
where he inquired of the inhabitants and of workmen in 
other employments in the vicinity, though they complained 



* Hygiene Publique. 
6 



62 VAGARIES OF SANITARY SCIENCE. 

loudly of the nuisance, they admitted that their health never 
suffered. 

The children here were in the best of health ; so were the 
women. One of these particularly attracted the notice of 
Parent on account of her fecundity ; he says she was " kabi- 
tuellement enceinte f' her children had great force and vigor. 
He had seen this mother nurse her infant and toss it after- 
wards into the carcass of a horse for a cradle. When the 
cholera arrived in Paris it appeared to shun Montfaucon ; 
the mortality from that disease here was very small in com- 
parison with the rest of Paris. 

The village of Noisy-le-Sec received the refuse of the 
Montfaucon establishments. M. Dumoissin, the mayor, told 
him that those nearest the animal remains suffered the least 
during the epidemic ; that his observations had destroyed all 
his previous opinions respecting these putrid matters, and 
that the peasants who handled them, far from thinking them 
harmful, believed that their fermentation purified the air. 

Fleury,* after reviewing the evidence respecting emana- 
tions from putrid animal substances, says, in view of no in- 
creased mortality nor increase of infectious diseases in the 
presence of immense masses of putrefaction, we not only 
recognize their innocuousness, but perhaps must admit that 
these emanations exercise a favorable and prophylactic 
influence. 

■ Dr. John Snow f says the mortality of persons engaged in 
any occupation is the best criterion of its salubrity. The 
death-rate of males of twenty years and upward in London 
for eighteen months ending July, 1856, was 241 per 10,000. 
The death-rate for those males of twenty years and upward 
who were employed in trades where organic decomposition 
was continually going on was 201 per 10,000 in the same 

* Cours d' Hygiene, 1852. 

•j- London Lancet, vol. ii., 1856. 



THE AIR. 63 

time. Dr. Snow estimates that a man working with his face 
one yard from offensive substances would breathe ten thou- 
sand times as much of the gases given off as a person living a 
hundred yards from the spot. He says the health of persons 
employed in any occupation is necessarily the measure of 
the effects of such occupation on the public health. Bone- 
boiling, skin-dressing, and other offensive trades are carried 
on at Lambeth ; this part of London contains many of the 
other causes that are supposed to promote cholera; the 
ground is low, covered by a poor, crowded population ; yet 
the deaths here from cholera in 1854 were 29 per 10,000, 
whilst in London at large they were 45 per 10,000. Dr. 
Snow concludes that " the science of public health, Hke 
other branches of knowledge, may be as much benefited by 
the removal of errors which stand in the way of its progress 
as by direct discovery." 

Dr. R. F. Foote writes to the Sanitary Review * that out- 
side the doors of the houses in Constantinople is a heap of 
animal and vegetable rubbish ; dogs are the only scaven- 
gers ; apartments are overcrowded, several members of a 
family living and sleeping in one room ; there is no drain- 
age ; large cesspools are near the houses, and the privy is 
on the ground-floor beneath the living-room. " With all 
these deficiencies, we are bound to consider Constantinople 
a healthy city." The result, he thinks, is due to " climate," 
and whatever may be the causes which tend to affect the 
public health, it is not the less true that it is more flourish- 
ing in Constantinople than in any other of the large towns 
in Europe. 

Dr. William Budd f says nothing proves the falsity of the 
pythogenic theory of fever more than the summers of 1858- 
59 in London. Here "an extreme case, a gigantic scale in 
the phenomena, and perfect accuracy in the registration of 

* Vol. iv., 1857. f British Medical Journal^ iS6i. 



64 VAGARIES OF SANITARY SCIENCE. 

the results — three of the best of all guarantees against 
fallacy — were all combined to make the induction sure." 
" For the first time in the history of man the sewage of two 
million people had been brought to seethe and ferment 
under a burning sun in one vast open cloaca in their midst." 
Stench so foul had never ascended to pollute the air. 
" Never before had a stink risen to the height of an historic 
event." The law courts were broken up by the noxious 
vapor ; the steamers lost their usual traffic ; day after day 
were passionate appeals from " those condemned to live on 
the Stygian banks." " Members of Parliament and noble 
lords, dabblers in sanitary science, vied with professional 
sanitarians in predicting a pestilence." " Meanwhile, the 
hot weather passed away ; the returns of sickness and mor- 
tality were made up, and, strange to relate, the result showed 
not only a death-rate below the average, but as the leading 
pecuHarity of the season, a remarkable diminution in the 
prevalence of fever, diarrhoea, and the other forms of disease 
commonly ascribed to putrid emanations." 

Dr. Letheby, in his report, said, *' With all this condition 
of the Thames, however, the health of the metropolis has 
been markedly good; in the corresponding period of 1857 
the cases of fever, diarrhoea, and dysentery attended in the 
city by the medical officers of the unions amounted to two 
hundred and ninety-three of the former and one hundred 
and eighty-one of the latter ; but during the past quarter, 
the quarter of the stench, there were only two hundred and 
two of the former and ninety-three of the latter." " So that 
while pythogenic compounds were poisoning the air with a 
forty-thousand fever-power, pythogenic fever, so far from 
rising in proportion, fell vastly below its average." 

Dr. McWilliams, the medical supervisor, said that not 
only was the general sickness less in 1858-59, but he adds, 
" As regards the type of those forms of disease (including 
diarrhoea, choleraic diarrhoea, dysentery, etc.) which in this 



THE AIR. 65 

country noxious exhalations are supposed to originate, we 
find the additions for the four hot months from this class of 
complaints 26.3 below the average of the three previous 
years, and seventy-three per cent, less than that of 1857." 
Dr. Budd says, " Before these inexorable figures the illusions 
of a half-century vanish in a moment." 

The irrigation of lands with sewage on a large scale had 
been in operation in Milan and Edinburgh for one hundred 
and fifty years before the dawn of Sanitary Science. It was 
really nothing more nor less than manuring fields, a process 
which had been going on by nature and art since the foun- 
dation of the world. The proposal to so dispose of the 
sewage of cities was a grand occasion for the exercise of 
sanitary fancy to awaken anxiety about the public health. 
As usual the sanitarians made no investigations, no inquiries. 
They simply let their imaginations have play, and cried 
aloud that the emanations from these farms would produce 
pythogenic diseases ; sewage would percolate into the wells ; 
the sewage was charged with the ova of entozoa, and was 
certain to cause tape-worm and other entozoic diseases in 
man and animals ; and " the effects of sewer-gases were 
never so bad as when sewage was spread out on the land ;" 
that the propagation through sewage " of certain epidemic 
diseases, especially cholera, enteric fever, and diarrhoea, 
among communities is one of the best-established facts in 
Sanitary Science." Horses and cattle that would eat the 
grass grown on these lands would be diseased ; milk and 
butter would be poisoned, vegetables grown here would not 
only absorb the sewage but the germs of disease. 

At Gennevilliers, where a farm took about one-half of the 
sewage of Paris, they said that the grass and the vegetables 
took up the filth.* " You can break them and squeeze 
water out that has a decided smell of sewage." One sani- 



* Sewage Disposal, Robinson. 
6* 



66 VAGARIES OF SANITARY SCIENCE. 

tari'an said he was now " in a position to explain the occur- 
rence of typhoid fever from the use of milk." 

These predictions of disaster retarded and hampered the 
profitable undertakings. The hue and cry about the public 
health, sometimes prompted by fear and sometimes by self- 
interest, was so great that governments were forced to in- 
vestigate these farms; always with the same result, — that 
this broadcast flowing of sewage was proved to be innoxious. 
It was shown in some cases that there had been a decided 
and constant fall in the death-rate among the inhabitants on 
and about these fields after the flow of sewage had begun. 
In Norwood district, where there is a sewage farm of sixty 
acres, the death-rate had fallen* from 18.6, the average of 
three years ending 1865, to 13.4, the average for the seven 
years ending 1872. At other farms the death-rate was 
equally low. At Breton one hundred and twenty-one acres 
take the sewage of five thousand people ; the workmen here 
are uniformly healthy ; the water is drained five or six feet 
from the surface ; it is clear and free from odor, and is proved 
to be of good quality. The Aldershot field of one hundred 
and twelve acres takes two hundred thousand gallons daily 
of sewage. At Banbury, Rugby, Carlisle, and other places, 
although some of the grounds are reported in a condition 
of negligence, the workmen and inhabitants are all in good 
health. 

Dr. Arnott had explained exactly how the Edinburgh 
farm would cause epidemic disease. Professor Christison said 
his prejudices for years had been against the irrigated 
meadows there, but he had been forced to surrender them. 
The nuisance was not denied ; it was sometimes intolerable ; 
but he was satisfied that neither enteric fever nor diarrhoea 
nor dysentery nor diphtheria, either in epidemic or non- 
epidemic seasons, was found in and around them more than 

* London Lancet ^ 1873. 



THE AIR. 67 

elsewhere. Dr. Arnott had said these fields must cause pes- 
tilence. Professor Christison declared that the fact remained 
that they had been there for two hundred years and no dis- 
ease could be ascribed to them ; indeed, if any part of Edin- 
burgh was freer than another from zymotic disease it was 
these sewage-irrigated meadows. 

M. Durand Claye * reports on the farm at Gennevilliers ; 
he says the plain here is a proper filter to absorb and purify 
impure water ; that under the thin layer of earth, where the 
sand and gravel begin, there is no trace of organic matter ; 
a proof that the superficial layer of earth is a complete filter 
(un filtre energique) for the sewer-water. From a well in the 
midst of the fields the water was pure, limpid, and tasteless 
[parfaitement pur de matures fermentiscibles). The water 
from the drains is equally pure. The death-rate here had 
been steadily declining since the farm was established. 

Professor Corfield says that when a sewage farm is a large 
filter and the effluent water is collected in subsoil drains, this 
water is perfectly fit to drink. He knows where it is usually 
drunk by the workmen. The farms have not caused by 
noxious emanations any injury to the health of neighbor- 
hoods where they have been placed ; there is no evidence 
that the sewage affects the wells ; and he does not think there 
is a single case where sewage farms, " badly conducted as 
many of them are," have caused the least injury to health. 

At Sherburn, Massachusetts,t the water that leaches from 
drains five feet deep beneath the surface of the sewage farm 
is as clear as spring-water, and was selected as such by an 
expert. 

Iq i888,t M. Ogier reported to the French government 
on the condition of the farm at Gennevilliers. His conclu- 
sion was that no better or safer way of disposing of the Paris 
sewage could be devised. 

* Annales d' Hygiene, 1875. f Sanitarian, vol. xiii. 

\ Annales d'Hygidne. 



6S VAGARIES OF SANITARY SCIENCE. 

In the summer of 1890, Dr. Henry J. Barnes * visited the 
sewage farms of Edinburgh, Birmingham, Leamington, and 
Croydon in England, and Gennevilliers, near Paris. The 
health officers at Edinburgh and Leith declared their hos- 
tility to the sewage irrigation ; but admitted that the district 
was " most healthful," and that there was no evidence of any 
injury resulting from the sewage. During the cholera epi- 
demic at Leith and Edinburgh in 1865-66, although these 
farms received the cholera evacuations, not a case occurred 
on them or in their vicinity. At none of the others that 
Dr. Barnes visited in England was there any disease re- 
ported as springing from the sewage. He inspected Genne- 
villiers on a hot day in August, and drank of the effluent 
water of the sewage, being assured of its purity. The in- 
habitants here were engaged in raising funds to erect a 
monument to M. Durand Claye, who, regardless of threats 
of personal violence, of persecution by lawsuits, and opposed 
by nearly all the savans in Europe, had caused the trans- 
formation, through this flow of sewage, of sixteen hundred 
acres of barren sand into a beautiful garden. The town had 
increased in population thirty-five per cent, since 1868. The 
death-rate for five years preceding the irrigation was 32 per 
1000 ; for the last five years it has been less than 25 per 1000. 
In 1882, when typhoid fever raged in Paris, there was no in- 
crease in Gennevilliers ; and not a case of cholera was here 
in 1884, when this disease was epidemic in the city. 

In 1 88 1 a pecuniary loss was reported f from the sewage 
farm at Reading ; but " looked at from a sanitary point of 
view, the farming operations had been a great success." 
Reading had never before been in such an excellent sanitary 
condition. 

In Chemical News, % Mr. Hope, an enthusiastic advocate 



* Boston Medical and Surgical Journal, 1891. 
I London Lancet, vol. ii. % 1880. 



THE AIR. 69 

of sewage farms, suggests a convalescent hospital for diseases 
of the chest in the midst of his sewage fields, " guaranteeing 
to the patients a certain number of irrigations in the month 
with genuine unadulterated London sewage ;" " where Lon- 
don beauties might come to recruit their wasted energies at 
the close of the season, attired in a costume de circonstance ^ 
with coquettish jack-boots; and would perhaps at times 
Hsten to a lecture on agriculture from the farmer himself, 
while luxuriating in the health-restoring breeze." 

Through this system of sewage-disposal much waste land 
had been brought under cultivation, which had afforded 
employment and subsistence for a large number of people. 
The sanitary terrorists had done all they could to prevent it. 

Dr. H. Gibbons, Sr.,* says that the origin of enteric and 
kindred fevers has been associated with filth ; to deny this is 
rank heresy. Nevertheless, facts will sustain the assertion 
that the specific causes of infectious disease have no odor ; 
that in the majority of cases the localities where the vilest 
filth exists are free from infectious diseases. " Objection may 
be made to this view, that it is a defence of carelessness or 
filthy modes of life. But it is simply a defence of truth. 
There is a seeming policy in holding before the eyes of com- 
mon people the spectre of death lurking in filthiness and 
foul odors. But cleanliness is virtue in itself enough to be 
cherished for its own sake, and not enforced by false ter- 
rors. Still more should the error be avoided by the medical 
inquirer." 

Dr. Gibbons says that in San Francisco the health authori- 
ties require the Chinese to have five hundred cubic feet of 
air to each occupant. The public health is supposed to 
demand this law. If they are found with less, they are fined 
and imprisoned. " I have seen in the county jail as many as 
thirteen Chinamen confined in a single cell about twelve feet 

* Pacific Medical and Surgical Jouitial, 1882. 



70 VAGARIES OF SANITARY SCIENCE. 

square, containing by computation less than ninety cubic 
feet of air to each ; and this for violating the five hundred 
cubic feet of air ordinance." 

The city of Oakland, built on a sand flat, has until within 
a few years obtained its water from shallow wells dug fifteen 
or twenty feet deep, whilst all the sewage and filth of the 
city was deposited in the soil about them. " But Oakland 
is and always has been a healthy locality, having much less 
of typhoid fever and diphtheria than scores of cleanly, well- 
drained, and hilly places on the Pacific coast." After citing 
other cities similarly situated to Oakland, Dr. Gibbons con- 
cludes : 

'^ First. The specific poison of infectious diseases has no 
odor. 

" Second. It may be associated with offensive odors, and it 
may not. In by far the larger proportion of cases it is not. 

" Third. Offensive odors cause no permanent disease. 

" Fourth. Certain emanations offensive to smell, notably 
if sulphur be the basis, tend to destroy organic germs. 

*^ Fifth. Water which has been polluted by excrementi- 
tious or other organic matters is mostly drunk with impunity ; 
the gastric juice digesting or destroying the organic germs. 
The production of disease by such water is the exception 
and not the rule." 

Professor M. P. Cazenave,* of the faculty of Lyons, gives 
an account of his visit to Tunis. " There is," he says, " a 
net-work of sewers here without any regular slope, open to 
the air, filled with excrement and animal and vegetable re- 
mains, the accumulation of years. The ground-work of 
these sewers is not protected by masonry, so that the soil is 
impregnated with filth and the atmosphere is loaded with 
fetor. The cemeteries are in a dreadful condition, the 
cofifins being placed only a httle below the surface. What 

* Annales d'Hygidne, vol. xvii., 1887. 



THE AIR. 71 

becomes," asks Professor Cazenave, " of that aphorism of 
public hygiene of Fonssagrives, that a city's health is in pro- 
portion as its sewerage is perfect and its cemeteries well 
arranged ? In spite of its condition, Tunis enjoys as good 
health as the greater part of European cities. Here is a 
striking example {confirmation eclatante) of the falsity of 
the opinion that ascribes a dangerous quality to a repugnant 
and detestable atmosphere." Unwilling to yield all his prej- 
udices, the professor says, when these sewers are remade 
and this old infiltrated soil is stirred, where are sleeping 
legions of infectious microbes, an explosion of typhoid and 
cholera may result. "But for the moment let us register 
this fact :" the " vast sink that represents the subsoil of 
Tunis engenders odors, but does not engender epidemics." 
Typhoid fever is rare here. It is our troops who are lodged 
often on the heights under apparently satisfactory conditions 
that furnish the greatest amount of typhoid fever {qui payent 
le tribut le plus large). 

The professor wished to believe that the people of Tunis 
had some hereditary resistance ; that there had been some 
natural selection whereby the fittest had survived and the 
feeble eliminated ; but the constant stream of European immi- 
gration had not been the occasion of any epidemic, and he 
says we must conclude with Bouchardat, that these odors 
are innocent ; and he asks. May not sulphuretted hydrogen 
and its compounds, which are constantly disengaged from 
these places, be antiseptic and destructive to certain classes 
of microbes ? En resume, he says science demonstrates that 
our senses are not competent as guides in hygiene. 

The testimony of travellers and residents in China — 
missionaries and physicians — is abundant and uniform as 
to the disregard in that vast empire of everything which is 
considered with us as sanitary precaution. Dr. Wilson * 

* Medical Notes on China. 



72 VAGARIES OF SANITARY SCIENCE. 

says the Chinese import no manure and derive no benefit 
from agricultural discoveries in Europe. Close to houses 
are placed large earthen vessels which receive all decom- 
posable refuse, to which is added urine ; in the corrupting 
mass at a heat from 80° to 86° multitudes of maggots form, 
giving to it life and motion. These pans are arranged along 
the public walks ; when putrefaction is at its highest point, 
the contents are carried in open buckets on the shoulders 
of men to the fields. Human ordure is carefully collected 
and highly valued. The water in the canals is filthy in the 
extreme; the banks are lined with ooze and abound in 
animal and vegetable products ; the offal dams up the canals 
and the stench is unbearable. 

Dr. Wilson reports that the English crews had fever and 
ague, but little dysentery, and typhoid or continued fever 
is not alluded to. 

Williams * says the streets in Canton are twelve, many of 
them only eight, feet wide. Public necessaries and offal are 
borne through them ; they pollute the air ; the sewers often 
get choked and exude their contents on the walks. The 
ammoniacal gases generated by this filth aggravate oph- 
thalmic disease, and it is matter of surprise that cholera, 
plague, or yellow fever does not visit this people. The 
Chinese transport cakes of human manure through the 
streets, thus creating an intolerable nuisance. Tanks are 
dug by the wayside ; pails are placed in the streets for the 
convenience of the people. Urine, faeces, soot, bones, fish, 
mud from canals, offal of all kinds are thrown into them. 
Fermentation takes place, maggots swarm, and the disgust- 
ing mass is conveyed through the streets. 

Mr. Williams says that, in general, the Chinese enjoy good 
health. They are as long-lived as other people. Ophthal- 
mia, dyspepsia, cutaneous and digestive diseases, and where 

* Middle Kingdom. 



THE AIR, 73 

there is rice-culture, intermittent fevers prevail. Cholera 
has raged in some parts of the empire, but has never been 
epidemic at Canton. When it has appeared in China, it has 
invaded some towns and passed by others just as obnox- 
ious. 

Surgeon John Rose * says that cholera at Shanghai is 
sometimes seen sporadically, but is seldom or never epi- 
demic. He says it is remarkable, considering the filthy 
condition of the canals, that violent epidemics do not more 
frequently come, for the canals which supply the people 
with water for domestic use are the receptacles of all sorts 
of refuse. 

Dr. F. Wong f says that during a residence of more than 
ten years in Pekin, he has seen only two cases of typhoid 
fever among foreigners. This is more curious, he says, 
as the conditions usually supposed to be productive of that 
fever are here in full operation, and large numbers of people 
use water and inhale air charged with the impurities of 
human excreta. 

In 1873, J Dr. Dudgeon writes of the remarkable exemp- 
tion of the inhabitants of Pekin from fever : " If foul smells 
create fever," he says, "there ought to be no immunity 
here." The condition and mortality of Pekin explode the 
belief that offensive odors are harmful. Hundreds of peo- 
ple live in and around and above cesspools, yet look well 
and healthy. He adds, " Many diseases prevail here, as in 
the West, without the agency of this reputed cause, — nox- 
ious odors ; and the causes exist at all times here without 
producing such diseases." 

The most convincing proofs of the sanitary condition and 
freedom from zymotic disease in China are found in the 
reports for twenty years of the medical officers of the Impe- 



* London Lancet, vol. i., 1862. 

f Ibid., vol. ii., 1872. \ Ibid., vol. ii. 

D 7 



74 VAGARIES OF SANITARY SCIENCE. 

rial Maritime Customs. There is a remarkable uniformity 
of statement from these physicians, scattered over a thou- 
sand miles in extent of this country. These reports are 
made half-yearly, and contain an account of the health and 
prevailing diseases in China among natives and foreigners. 
Except small-pox and occasional limited epidemics of cholera 
and one of diphtheria, which occurred in Pekin in 1866, 
no outbreak of any importance is recorded for twenty-five 
years. 

From Ichang, the doctor writes, " Why disease is not 
always with us, not why epidemics should sometimes come, 
is the problem," and the immunity from disease " must be 
ascribed to meteorological conditions." " In Corea small- 
pox, ague, and cholera are reported ; typhoid ought to be 
common, as all the conditions are favorable to its existence; 
as yet(i885), however, no cases have presented themselves." 
In 1886, Dr. McFarland reports the sanitary condition of 
Ichang as most deplorable, but there " is an absence of 
epidemic disease." 

At Han-Kow, in spite of the filthy condition, the health of 
the city compares favorably with that of any port in China. 

Dr. Lowry writes that at Parkoi animal and vegetable 
substances lie decomposing on all sides ; privies are open 
in the most exposed places ; the houses are little better than 
the streets ; in some of them an open gutter runs through 
into which all filth is thrown ; the floors are saturated with 
excrement and the stench is vile. The diseases that he 
mentions as occurring here are scrofula, skin-diseases, small- 
pox, and syphilis. He makes no allusion to typhoid fever 
or diphtheria. 

Dr. White * reports no serious illness at Ching-Kiang ; on 
account of the filth " the wonder is that a man, woman, or 
child survives." 



[886. 



THE AIR. 75 

Dr. Deane wonders that there is so little sickness at 
Kuing-Chow. For twenty years these reports have been 
made, all uniform in tone, with a remarkable similarity in lan- 
guage, giving disgusting details of the vile sanitary condition 
of the country and its immunity from contagious disease. 

But Hebrew prophet, Christian martyr, Mohammedan 
fanatic, or Mormon saint never clung to his faith with 
greater tenacity than do these English medical men to 
theirs. Their reports are full of expressions of surprise that 
epidemics do not come ; they seem lost in wonderment ; but 
never express a doubt of the filth-theory of these epidemics. 

In 1886, however. Dr. Daly, the only dissenter in the 
group, in reporting on the health of Ning-Po, says we live 
in houses near large kongs filled with old and putrefying 
fseces, the accumulations of months, especially during the 
summer, when manure is not wanted for the fields. In 
spring and autumn they are removed in boats, which travel 
the canals where the natives wash their vegetables. " I 
have often seen women doing this within a few feet of a 
night-soil boat. On the banks of the canal on which the 
largest traffic of these boats occurs is situated the dairy 
that supplies most of the foreigners with milk, and in this 
canal the dairy-folk wash their utensils. No precaution is 
taken with the excreta from cholera or from fever patients." 
Dr. Daly seems in a little doubt about the pythogenic 
theory of the origin of typhoid fever, for he says, " If" it be 
a right one, it is not universally apphcable ; "if" it were, 
the disease would rage here, for everything to favor fecal 
decomposition exists, — warmth, stagnation, accumulation, 
and partial seclusion, — " yet no case of typhoid has occurred 
for many years among the foreigners, and it is an extremely 
rare disease among natives." 

The editor of the Chi7ta Medical Missionary, September, 
1888, asks, " Do sanitary measures limit disease in populous 
cities ?" He says a lesson can be learned from the condition 



76 VAGARIES OF. SANITARY SCIENCE. 

of Canton and hundreds of other cities in China, where 
generation after generation has passed without any benefit 
from sanitary measures. In other countries millions of 
dollars are spent under the direction of the ablest scientific 
men to ward off disease. But in China no attention is paid 
to the subject. "Wherein do the results differ ?" he asks. 
Canton has 1,500,000 inhabitants, and there are 333,333 
persons to the square mile ; the streets vary from five to 
eight feet in width, a few being twelve or fifteen ; the actual 
space for each person in the city is fifty-five and a half 
square feet. There are no drains in Canton; there are 
ditches loosely walled up, but there is no fall to carry off 
the water. The ditches are generally choked with filth, 
and offensive gases are poured forth. The water is derived 
from wells, the river, and springs. The impure river water 
is used by a small part of the population. The largest part 
of the water-supply is from wells four to ten or fifteen feet 
deep; a great part of this is the refuse water which has 
been used by the 1,500,000 people. " It percolates through 
the filth of the sinks and ditches, and then through soil 
which has been saturated for centuries with animal, vege- 
table, and saHne deposits." The custom of burning incense 
at the house-doors morning and evening is supposed to 
exert some counteracting influence on noxious gases ; but 
the writer truly says it does not differ from ordinary smoke, 
and only adds so much more carbon to the air in minute 
particles. Here is Canton, he says, on the border of the 
torrid zone, destitute of all the sanitary appliances which 
modern science pronounces essential for the pubHc health ; 
with a population three times as dense as that of any western 
city ; with impure water and abounding in filth and offensive 
smells, so that it is a by-word with travellers. A practice 
of thirty years convinces the editor that Canton is not more 
unhealthy nor is it any more subject to epidemics than 
Western cities. 



THE AIR. 77 

W. K. Burton,* professor of sanitary engineering at Tokio, 
gives an account of the sanitary condition of Japan. All 
faeces and urine are carefully stored in receptacles until 
fermentation is accomplished. The mass is then diluted 
and poured on the fields. The farmers and peasants who 
live near these putrid masses and handle them "enjoy 
remarkably good health," The professor says, '* It is not 
too much to say that the soil on which most of the large 
towns in Japan stand must be sewage-sodden, with the 
result, of course, of contaminating the air both inside and 
outside the houses." But the worst of all is, " the water for 
domestic purposes is drawn from shallow wells dug in this 
soil. The water, of course, is simply dilute sewage." The 
death-rate for the whole empire is 19.33 P^^ 1 000, while in 
the least healthy districts it is only 24.22 per lOOO of the 
population. 

The death-rate of Tokio, with its filthy air, water, and 
soil, and bad drainage, is 21.08 per 1000. 

The sanitarians assure us that the two most sensitive and 
unerring tests of the hygienic condition of a city or country 
are the proportions of infant mortality and mortality from 
zymotic diseases to the total number of deaths. These rela- 
tions are so intimate that, given the hygienic condition, they 
can predict the mortality, and vice vei'sa. 

Professor Burton says the infant mortality is very low in 
Japan, his explanation being that *' there is great attention 
paid to the children by their mothers." The mortality from 
zymotic disease is also very low. He gives a table, which, 
he says, is furnished by Professor Bealz, M.D., who has prac- 
tised in Japan for thirteen years. The table shows that in 
1888 there was a total of 756,367 deaths. Of these, 45,715 
are set down to infectious or zymotic diseases. 

In 1887 there was a total of 753,855 deaths, and 113,696^ 

* Sanitary Record^ 1890. 
7* 



78 VAGARIES OF SANITARY SCIENCE. 

were of five years and under, — only about one-third of the 
amount of infant mortality that occurs in our large cities. 
Professor Burton attributes this comparative immunity from 
infectious diseases to " climate." It seems never to have 
occurred to him as a possibility that the sewage-sodden soil 
of Japan, contaminating the air inside and outside of the 
houses, and the diluted sewage forming the drinking-water 
of the people may have nothing to do in the production of 
infectious disease. 

He says that Japan has acquired the title of " the Sanato- 
rium of the East." 

His statements are corroborated by the statistical tables 
of births and deaths shown at the second national industrial 
exhibition at Tokio, in i88i. The percentage of zymotic 
to total mortality for the year ending 1879 was 13.66, 
about one-half what it is in our cities which have the most 
careful sanitary supervision. The following year the per- 
centage of zymotic to total mortality rose to 19.13. The 
general death-rate for the empire was 17.01 per 1000 of the 
population. The percentage of mortality under ten years of 
age in 1879 was 28.70; in 1880 it was 25.76. For the year 
ending 1880 there were 2863 deaths from typhoid fever in 
the empire, and 534 from diphtheria. 

Professor Corfield * says that the large undrained cesspool 
and the latrines at Belgaum, in Bombay, have existed from 
time immemorial, with the wells in close proximity. " The 
whole ground in and about the lines is pregnant with abom- 
ination," with a mean temperature of 74° F. Yet, "as 
usual, at Belgaum there wag comparative immunity from 
fever," and " Belgaum has long possessed a reputation for 
salubrity." If Professor Corfield had not told us, we might 
have thought the salubrity of Belgaum depended on " cli- 
mate," as did that of China, or that '* great attention was 

* Treatment and Utilization of Sewage. 



THE AIR, 79 

paid to the children by their mothers," as in Japan. It was 
neither. Professor Corfield does not seem to be indulging 
in raillery when he says that the reason for Belgaum's salu- 
brity, surrounded by such putridity, is, " The town is laid 
out with some regularity, and the principal streets are kept 
in good order.'* 



CHAPTER IV. 
The Air — (Continued). 

If we turn to the reports of boards of health in our own 
country, the proof is no less abundant and conclusive that 
putrid emanations corrupting the air are not competent to 
cause disease. Those towns and cities which in these re- 
ports suffer the most obloquy on account of their filthiness 
appear in the mortality tables to enjoy the largest measure 
of health. In fact, our sanitarians offer the interesting phe- 
nomena of laying down certain inviolable principles of 
public hygiene, supporting them by the most flaming elo- 
quence, and then industriously and with apparent uncon- 
sciousness collecting an overwhelming mass of statistical 
testimony to show there is not a word of truth in the origi- 
nal propositions. 

The first report of the Massachusetts Board of Health 
contains an account of an inspection of the slaughter-houses 
at Brighton. " The stench about all of these places so kept 
is horrible ; and, although the day of inspection was a fine, 
dry one, with a free northwest wind blowing, the odor of 
some of them could be observed for more than half a mile 
very strongly." " Here is a putrid mass consisting of 
blood, which decomposes almost as soon as it falls upon 
such material, the excrement of the animals killed and of 



80 VAGARIES OF SANITARY SCIENCE. 

the hogs, the half-digested food contained in the entrails, 
and the offal itself, covered with decomposing matter ; in 
this filth the hogs wallow. The surrounding ground is fil- 
tered with decomposing matter. The slaughter-house hog 
not only eats flesh, but flesh in a state of putridity ; and is, 
therefore, entitled to be regarded as the carrion beast. If 
he is good to eat, so is the crow and buzzard. Few persons 
would be willing to eat him if they saw him in his putrid 
sty, with wreaths of entrails hanging about his neck and his 
body smeared with blood. Human instinct (which is some- 
times better than reason) recoils from such food. The 
slaughter-house pig-pens are filled with animal m.atter, with 
rotting blood, mingled with excrement, and are, therefore^ 
a source of danger to public health^ 

Close to this description the board admits that Brighton 
is not an unhealthy town ; that in 1865-66 its death-rate 
was less than that for the State; and there is no record, 
nor any charge, that anybody was ever made sick by this 
putridity. 

Amazing coincidence ! In the next report is a table of 
deaths of persons above five years of age from typhoid fever 
in Massachusetts for the ten years ending 1868. There are 
twenty-eight towns reported, which have a population of be- 
tween three and four thousand each. 



Towns. Population. 



Number of deaths 
from Typhoid Fever. 



Dennis 3592 43 

Harwich 3540 57 

Provincetown . 347° 18 

G. Barrington 3920 36 

Salisbury 3609 29 

Watertown 3779 19 

Greenfield 3211 56 

Palmer 3080 32 

Dartmouth 3435 29 

Easton 3076 30 

Groton , , 3176 28 



THE AIR. 8 1 



Tewns. Population. 



Number of deaths 
from Typhoid Fever. 



Medway 3219 30 

Wrentham 3072 22 

Milbury 3780 29 

Grafton 3961 58 

Ware 3374 4^ 

Amherst 3415 Zl 

Rockport 3367 26 

Ipswich 3311 23 

Deerfield" 3038 40 

Hollister 3125 26 

Stoneham 3298 29 

Wakefield 3244 19 

Webster 3608 62 

Braintree 3775 23 

Canton 3318 13 

Leominster 3313 21 

Spencer 3024 30 

The average population of the twenty-eight towns is three 
thousand three hundred and ninety-seven ; the average 
number of deaths from typhoid fever for ten years is thirty- 
two. Brighton's population is three thousand eight hun- 
dred and fifty-four; the number of deaths from typhoid 
fever for ten years ending 1868 is nineteen. In proportion 
to population, Brighton, with all its filth, so vividly described 
by the board of health, had only about one-half of the 
amount of typhoid fever that the other twenty-eight towns 
had, which were not reproached for uncleanness. Yet, in the 
same book. Dr. Derbe says that typhoid fever is " born of 
impurity." As Dr. Budd would say, " Before these inex- 
orable figures, the illusions of a, half-century vanish in 
a moment." The board ascribes the salubrity of Brighton 
to its favorable location and to the good condition of its 
people; it says nothing about the location of the other 
twenty-eight towns or the condition of their people. 

The Massachusetts Board (1879), in discussing the cause 
of typhoid fever, says, " Since the investigations of the board 
/ 



82 VAGARIES OF SANITARY SCIENCE. 

have been directed to this point, it has repeatedly been 
shown that immense amounts of urine and excrement, — 
oxydized, incompletely oxydized, — and as they come from 
the bladder and intestines, are consumed in drinking-water 
and inhaled at the rate of nine thousand litres of contam- 
inated air a day, and this for years by young, old, and mid- 
dle-aged persons, without any disease resulting that may be 
attributed to filth." 

The same board's report for 1 880 contains an account of 
an inspection of schools in that state by Mr. E. W. Bow- 
ditch. Some of the schools in New Bedford have standing 
water in the cellars ; a great many bad smells are reported ; 
disgusting urinals and privies scarcely fit for animals, much 
less for human beings. In one school peppermint showed 
ten leaks in the plumbing; the drains were not tight in 
another ; in another a " sickening smell" pervaded the build- 
ing, and untrapped wastes connect with sewers ; at another, 
sewers and private drains ventilate into the building, and 
some of the schools are supplied with water from a " sus- 
pected well." These buildings have a seating-capacity of 
four thousand six hundred and twenty-six ; this year there 
had been altogether one hundred and fifteen cases of scarlet 
fever and diphtheria, some measles, and in one school " some 
sickness." 

The Lowell schools were in equally bad condition, and 
in equally good health. The privies in one school were in 
the worst order he had ever seen. 

This eminent sanitarian is always so rich in details that 
we cannot help giving them in his own words. " At one 
school the rear of the building on the boys' side seems to 
be used as the common urinal ; on the side and front walls 
of the building were counted eight different places urinated 
upon and wet at the time of inspection." Mr. Bowditch is 
kind enough, however, to add, ** It is stated that this was 
doubtless owing to boys from outside the school." At 



THE AIR. 83 

Bartlett Street school " the boys have urinated on the walls 
of the building within five feet of the entrance-door !" Mr. 
Bowditch seems to have lost all patience with these auda- 
cious and depraved youths who are violating the funda- 
mental principles of Sanitary Science ; for he withholds his 
absolution from the boys of the Bartlett school, and very 
likely would not believe the young rascals if they laid their 
tricks to " the other boys." 

The Cedar Street school has six rooms, with seats for 
about three hundred pupils. The ventilation is by windows 
only. There is standing water in the cellar within two feet 
of the cellar floor. The water-closets are in the basement, 
and the ceiling is neither lathed nor plastered. " There is a 
sickening smell up to the top of the basement stairs." " Pep- 
permint showed that the drains were not tight in the base- 
ment." " There is a pig-pen on the opposite side of the 
street, and a neighbor's privy and poultry-yard seventeen 
feet of one side of the building, and fourteen school-room 
windows look out on them." " There have not been many 
absences lately ; not over twenty from sickness ; but two 
deaths, and these happened during vacation." In the High 
School, " cellar air" is used for the steam radiators ; a num- 
ber of these are so situated that " water-closet air instead of 
cellar air" is introduced into certain rooms. No sickness is 
reported in the High School. Mill Street school is in very 
bad sanitary condition, but Mr. Bowditch says " there is very 
little sickness of any kind." At Maxwell Street school is 
an untrapped sink. " Smells here come up the sink, but it 
is not known whether from a cesspool or privy." " One 
case of sickness only" is reported at this school. 

Mr. Bowditch * inspected the summer resorts of Massa- 
chusetts. As far back as 1869, Dr. Derbe, he says, had pre- 
dicted that Martha's Vineyard would " sooner or later be 

* Massachusetts Board of Health Report, 1879. 



84 VAGARIES OF SANITARY SCIENCE. 

visited by pestilence." Here he found privies, " shallows in 
the ground or on the surface," and the drinking-water is 
reached at from eight to twenty-five feet. The population 
in summer is about fifteen thousand, and at the height of the 
season it reaches double that amount. There are two ponds 
here that are veritable cesspools for the filth created by the 
thousands of visitors ; rank marsh grass, masses of refuse 
sewage, " everything that is nasty," can be found in these 
ponds. 

All over the town, sinks deliver their water from six to 
fifty feet from wells ; the privies are not much farther off; 
and there are no traps to the kitchen wastes. At one large 
hotel the swill-barrel almost touches the well ; across the 
street is a mass of filth several inches deep. The " proprietor 
states it is hoed out every autumn." One public-house has 
" several privies within a radius of fifty feet." The old well 
has six privies within twenty-five feet. Another house has 
its well within a foot of a sink-drain. The proprietor admits 
that the drain is a little too near the house, for the stench 
keeps him awake nights. The well at another house is 
seventeen feet from a cesspool ; it is such " beautiful water" 
that the neighbors come for it. 

Another house has a well within twenty-five feet of one 
cesspool and four privies. This well is used by five families. 
Another house has twenty-four privies and thirteen cesspools 
within a radius of one hundred and forty feet ; the well here 
is used by a number of families. At another house fourteen 
privies could be counted, " all within range." Of forty-two 
wells that were examined, the water of twenty-two was found 
impure. 

Mr. Bowditch mentions only two cases of sickness as 
having occurred at Martha's Vineyard. 

Into the large boarding-houses sewer-gas was flowing; in 
one, peppermint poured into a basin permeated all the others ; 
and it is the habit to empty chamber-slops into the basins. 



THE AIR. 85 

In one of these houses there had been " one case of sore 
throat during the past summer." In a hotel for one hundred 
and fifty guests, none of the joints in the plumbing were 
tight ; here, Mr. Bowditch states, " there has never been a 
serious case of illness in the house for sixteen years." 
Another house takes one hundred and seventy-five guests ; 
the soil-traps here are all unventilated. A field one hundred 
and eleven by forty feet received all the soil-pipe matter. 
Outside the house is a two-story privy, with twelve sections; 
the pipes between the second and third floors leak sewer-gas. 
" There has been no sickness in the house." Visits to other 
resorts showed an equal amount of filthiness, and a cor- 
responding amount of good health. 

We cannot sufficiently admire the school-girl naivete of 
the eminent sanitarian who records these inspections. The 
humor of the situation lies in this, that he seems entirely 
oblivious of the fact that he is accumulating the best of 
evidence to show that the filthy condition of these places had 
nothing to do with the production of disease. 

The Rhode Island Board of Health Report for 1883 nar- 
rates an inspection of thirty-nine summer hotels in that 
State. These were reported in good sanitary condition ; and 
it is comforting to note that just as large a measure of health 
prevailed in them as in those which were reported in bad 
sanitary condition by Mr. Bowditch. 

But nothing which the reformers themselves have col- 
lected can illustrate the harmlessness of filth like the sani- 
tary history of Newport. It is recorded in the Sanitarian^ 
vols, ix., X., and xi. As early as 1872, Dr. Sims was taken ill 
at Newport, and ascribed the attack to impure water ; but it 
was 1878 before the public was aroused, or even suspected 
the dangers which menaced the city with destruction. It 
was now found out that blasting epidemics were ready to 
explode, on account of the filth which had been " deposited 
here for two centuries." The wells were fed " by springs of 

8 



86 VAGARIES OF SANITARY SCIENCE, 

dead water that has passed through the bodies of a whole 
neighborhood." In summer, when there was the greatest 
accumulation of refuse, there was the most obstruction to 
the outflow of sewage, and there is an " accumulation of 
festering filth." " Newporters are sleeping over a smoulder- 
ing fire which will ere long break forth like a volcano !" 

In winter the houses are ventilating-chimneys, " sucking in 
from all directions foul air from the soil ;" and there is no 
barrier from the organisms which swarm in the ground-air 
around leaching cesspools, leaky drains, or the filthy-made 
ground." Newport was destitute of sanitary authorities. 
Of all the well-water analyzed in i88i, only one specimen 
was good. By December of the same year it was found that 
Newport's ice was contaminated with sewage, and the public 
water-supply was polluted. Professor Raphael Pumpelly 
has proved that water filtered through one hundred feet of 
sand will retain its impurities. 

It was affirmed that Newport's Common Council " gloated 
in municipal dirt ; its sensibilities were so blunted by muni- 
cipal filth that it was incapable of appreciating the advan- 
tages of cleanliness." 

The pest-wagons of night-scavengers and leaky swill- 
carts traverse the streets, dribbling their filthy contents all 
over the city. Back-yard excrement-storage, cesspools, 
piggeries, manure vaults, and various factories add to the 
soil-poisoning and welcome "the patrons of fashion and 
fever." " Filth reigns supreme." The waters of the wells 
differ only in degrees of impurity. Newport's water is 
doubly poisonous ; it has too much solid matter, and is also 
poisoned by leakage from cesspools. Its air is laden with 
cesspool effluvia. The city is blind to dangers depending 
on foul water, air, and soil. It is now discovered that barn- 
yards and privies drain into the pond where ice is cut. The 
City Council is obstructing sanitary reform ; it has permitted 
certain portions of the city to become a perfect nuisance. 



{ 



THE AIR. Sy 

In spite of the winter's rain and snow (i88i), "the stench 
from the polluted soil is very evident." 

Consulting sanitary experts were hurriedly sent for. Dr. 
Bell, of New York, said Newport's greatest evil was a water- 
logged soil ; so that in winter, the cellars being warm, they 
soak in all moisture which cannot be absorbed ; this mingles 
with the vapors and is carried with them up through the 
houses ; these cellars are malarious nides ; and he told the 
dreadful truth that the dangerous constituents of cesspools 
were absorbed into the soil, while the inert, harmless residue 
was carried away. Dr. Bell said that if, in addition to soil- 
dampness, further dampness were added, the danger in- 
creased, making a most offensive condition, " dark, mouldy, 
and to be likened only to the clammy sweat of death." 

The experts found things so bad as to allow no possibility 
of doubt as to the relation of cause to effect in producing 
disease,- — soil-pipes broken and cracked, joints with no 
cement, some pipes plugged up entirely, and a backward flow 
of sewage into cellars and under basement-floors, '* poisoning 
the water, though to the taste it seemed excellent." The 
experts found only one house in Newport that had not sani- 
tary defects, and in this the furnace took the air direct from 
the cellars. Several of the houses were " mere death-traps." 

"Go into any of the hotels, from the greatest to the 
smallest, and you will find the air laden with cesspool efflu- 
via," wrote Dr. Sims. Dr. Peters said he had never seen a 
street so fair and yet so foul as Bellevue Avenue ; and he 
described other streets of approximate filthiness, where were 
smells from drains, sewers, and out-buildings ; out-houses 
were clustered so closely as not to allow circulation of air ; 
and he did not believe that delicate persons could recover 
their health here. 

In 1882, Dr. Storer writes,* " The excitement in Newport, 

* Proceedings American Public Health Association. 



88 VAGARIES OF SANITARY SCIENCE. 

which was already blood-warm, has risen far above fever- 
heat." A meeting was called of the summer residents, rep- 
resenting a capital of twenty millions of dollars. The clergy 
took an active part ; the ladies joined the Sanitary Protec- 
tive Association, and by vote and voice cheered the move- 
ment on. Dr. Storer writes that in 1876 nearly one-fourth 
of all deaths in Newport were from zymotic diseases ; in 
1877 these were one-sixth of the whole, in 1878 more than 
one-sixth, and in 1879 nearly one-fourth. "What more 
startling evidence than this," he cries, " of all that the sani- 
tarians have asserted concerning Newport can be asked 
for ?" Besides, there are eleven undertakers here ; and now, 
to add to Newport's horrors, opium-taking, whether as a 
cause or effect of the filth, is going on to such an extent 
that " there are thirteen habitual opium-drunkards," who 
use over thirty-four thousand grains of opium each month. 

In all this sanitary delirium only twice is there any record 
of any one having tried to face the danger with anything 
like composure. At one of the meetings of the Sanitary 
Protective Association, Mrs. Lieber asked what sanitary 
dangers were in Newport that did not exi^t elsewhere. 
And Mr. Davis timidly inquired if, theory aside, there had 
ever occurred any serious sickness from these causes among 
summer visitors. Both were quickly squelched; for the 
clergy and the doctors reasserted the dangers, and we hear 
no more from the remonstrants. They were very likely 
glad to keep still, lest, like the London obstructionists, they 
might be pointed out as " wallowing in their own filth." 

The sanitarians who reported on China, Japan, Belgaum, 
and Brighton told us why these places were so healthy ; 
none of them, however, condescend to explain the cause of 
Newport's salubrity. 

Mr. E. W. Bowditch, in his report of inspection at New- 
port, says, " Bearing in mind that the city water is undesir- 
able to use, that perhaps a majority of the wells are already 



THE AIR. 89 

tainted, and that the sewer system is of little or no value 
save to concentrate nuisances at certain points, that no pre- 
caution is taken against zymotic disease except to placard 
front doors, the apparent freedom from preventable sickness 
is remarkabley 

Newport has always enjoyed a world-wide reputation for 
healthfulness. Registration showed always a smaller death- 
rate than that of the State of Rhode Island at large ; and it was 
admitted that this low rate was augmented by the death of 
many invalids who were conveyed there in the last stages 
of illness. For ten years ending 1880 the death-rate for 
the State of Rhode Island was 15.9; that for Newport was 
14.5 per 1000 of population in the same time. It may be 
thought that this low death-rate depended on a low birth- 
rate. This is not so ; for Newport's birth-rate for ten years 
ending 1879 was 24.2 against 22.3 per 1000 for the State. 
In 1880 the per cent, of zymotic disease to total mortality 
was 28.09 ^"^^ th^ State and 17.35 for Newport; and nearly 
every year when this subject is mentioned in the Rhode 
Island reports, Newport is recorded as possessing advan- 
tages over the State. 

The period of sanitary activity began in Newport in 1880 
with the formation of the Sanitary Association. The period 
of sanitary law was established in 1885, when a board of 
health was organized. The board reports that a large 
amount of work had been done in removing unsanitary 
conditions. The air, water, and soil have been made purer 
by the improvements. Sanitary codes have been passed; 
sanitary inspections without number have been made. We 
naturally turn to the vital statistics to ascertain the effect 
of these measures on the health of the people. For the ten 
years ending 1890 the average general death-rate was 15.7, 
against that of 14.5 for the ten years ending 1880. For the 
six years ending 1890, the period of sanitary law, the aver- 
age general death-rate was precisely the same as the pre- 

8* 



90 VAGARIES OF SANITARY SCIENCE. 

vious six years, — namely, 15.73. If we look a little closer for 
the effect of sanitary law and sanitary measures on zymotic 
disease in Newport, we find that for the five years ending 
1884 there were 91 deaths from cholera infantum, and 114 
deaths from the same disease for the five years ending 1889. 
There were 22 deaths from croup for the five years ending 
1 884, and 30 from the same disease for the five years ending 
1889. For the five years ending 1884 there were 26 deaths 
from diphtheria, and for the next five years there were more 
than double that number, — namely, 56 deaths. There were 
46 deaths from typhoid fever for the five years ending 1884, 
and for the next five years there were 5 1 deaths from the 
same disease. In the mean time there was not much change 
in the population of the city. The State census made it 
about 19,500 in 1885, and the Federal count was about the 
same number in 1890. So we have the interesting phe- 
nomena at Newport of the removal of unsanitary conditions, 
and not only a marked rise in the general death-rate, but a 
decided increase of those diseases which the sanitarians tell 
us are caused by such unsanitary conditions. 

Inexplicable circumstance ! 

A few months after the culmination of the febrile sanitary 
excitement at Newport, Dr. Storer read a paper * before the 
Sanitary Protective Association of that city to show that it 
is one of the best places in the United States for consump- 
tives. He does not tell us how it can profit a man to gain 
immunity from phthisis only to be suddenly cut off by 
diphtheria, typhoid fever, and dysentery. The water-logged 
soil which the consulting sanitarian said was Newport's 
greatest evil, and from which was being sucked into the 
houses not only poisonous air but " organisms" of disease, 
has suddenly undergone a change. Dr. Storer says in his 
paper that one of the reasons of Newport's comparative ex- 

* Sanitarian, January, 1883. 



THE AIR. 91 

emption from consumption is the absence of " soil-moisture." 
Without a single word of warning against zymotic disease, 
or about " the clammy sweat of death," he entices not only 
the consumptive to Newport, but others, and that, too, in 
the winter, when the danger, according to the sanitary ex- 
perts, is at its height. He recommends its " soft, balmy, 
soothing, sleep-inducing climate in the amelioration and 
cure of nervous diseases." For nine months in the year " it 
is a veritable haven of rest." 

The citizens of New Haven,* says the health officer of that 
city, who have often been told of their danger, " go on year 
after year, rivalling a miser in storing up their own excre- 
ment and every other species of repulsive and loathsome nasti- 
ness in receptacles as near as possible to their own houses." 
" Where, then, is their boasted intelligence and their pru- 
dent regard for their families ?" And when, in the interest 
of these " suffering and stricken families," attempts are made 
by the wise and good sanitarian to deprive them of their 
" odorous and odious subterranean accumulations, they dis- 
pute their power." " They cry out, * Oppression ! Sacred 
rights of citizenship invaded !' and resistance to the utmost 
is threatened." " Look among the houses of the working- 
classes, and see how often the industrious mechanic and 
laboring-man is wronged and made the victim of his land- 
lord's power." There is no property, he says, which makes 
such large returns as that which is rented to the laboring- 
classes. " They need the protection of constituted au- 
thority." " This suffering and afflicted portion of our 
fellow-citizens have rights." In the masses of filth, which 
are stored so near dwellings, germs of disease find the most 
favorable conditions for existence. " Cesspools, filthy drains, 
and filth in any form afford a fertile soil for the reproduction 
of the typhoid-fever germ." In 1884 he reminds the people 

* Connecticut Board of Health Report, 1SS3. 



92 VAGARIES OF SANITARY SCIENCE. 

of their danger from cholera. He says a single evacuation 
from a cholera patient, thrown into a privy or cesspool, will 
infect a whole neighborhood. 

The people of New Haven had long neglected the warn- 
ing voice, and had often been rebuked by the sanitary 
officials for their stinginess in not providing money for these 
authorities. More liberal appropriations were now called 
for in view of the approaching epidemic. Their health- 
officer told them that never before had such timely notice 
been given to a people ; the fulness of time was come ; there 
was sure to be much sickness during the next summer; 
** whatever is done must be done quickly ;" "the occasion 
will admit of no delay." And now, as if ravished by the 
spirit of prophecy, the sanitary seer exclaims, ** The cholera 
will come to the country !" " The cholera will come !" * 
The impenitent citizens of New Haven huddled together 
and waited for the result, but seem to have held on to their 
money. That year, which was to bring such disaster to 
them, the general death-rate was 17.9 against 17.55 P^^ 
1000 for the year before, and the proportion of zymotic to 
total mortality was six per cent, less than that of the pre- 
vious year. 

New Haven went on storing up its filth, so that in 1885, 
when a census of the privies and cesspools was taken, it 
contained more than 12,000 of these structures, and there 
were not fewer than 5000 untrapped basins and kitchen- 
sinks "and otherwise defective plumbing." In addition 
there were nearly a thousand wells in daily use, most of 
them " less than twenty-five feet from some leaching filth- 
pit." 

In 1887 1 the health-officer of that city reports to the State 
board that the city board of health has been restricted in its 



* Connecticut Board of Health Report, 1884. 
t Report of New Haven Board of Health. 



THE AIR. 93 

action by having no sanitary ordinances. It has to learn of the 
" existence of infectious diseases as best it can." It is " still 
further hampered by parsimonious appropriations" from the 
City Council. In short, the board has neither power nor 
money. The city's air is pestilential, its water polluted, its 
soil contaminated, and there is no remedy. 

In the State Report for 1890, Dr. Osborn compares the 
death-rate of New Haven with what it was twenty-one years 
ago. In 1869 it was 23.37; ^"^ 1S89 it had fallen to 17.50 
per 1000 of the population. He compares the proportion 
of zymotic to total mortahty for the five years ending 1873 
with the five years ending 1888, and finds that the percentage 
of zymotic to total mortality in the first period was 2944, 
and that of the second period was 21.68. 

As the death-rate of Newport, both general and zymotic, 
went up with the removal of causes of disease, so did that 
of New Haven steadily decline as these causes were multi- 
plied. It is fortunate that we are not left to conjecture the 
reason of this decline. We could never have guessed it. 
Like China, New Haven had a " climate ;" the mothers there 
" take good care of their children," as in Japan ; like Bel- 
gaum, it is regularly laid out. If we had not been told the 
reason, we might have been contented with the fact that it 
was " remarkable," as at Newport. The health-officer of 
New Haven is not the man to leave us in the dark on this 
momentous subject. In a communication to the State Board 
of Health he says New Haven's sanitary condition is due to 
" moral suasion," 

The Connecticut Board of Health reports an inspection 
of the borough of Stamford in 1884. A stream here pol- 
lutes the air with a disagreeable stench, and there is no 
method to dispose of sewage. In a thickly-populated street 
there is a large blind-ditch, an elongated cesspool half a 
mile in length ; the ground on each side is infiltrated with 
sewage ; the ground under the houses is saturated with it, 



94 VAGARIES OF SANITARY SCIENCE. 

and the gases pass up through the buildings. The citizens 
of Stamford are hving over a "vast underground retort, 
generating its deleterious gases to corrupt the soil about its 
dwellings, poison the water of its wells, and defile the air of 
its houses." Stamford had been noted for its health for two 
hundred years. That very year its death-rate is recorded as 
14.6, against 15.6 for the county, and 16.6 per 1000 for the 
State. The next year frightful epidemics of diphtheria* 
broke out in Greenwich and New Canaan, two neatly-kept 
adjoining towns, in hourly communication with Stamford. 
Stamford escaped the disease. Was it the "vast under- 
ground retort" that protected it from diphtheria that year ? 

The same year an official inspection of summer resorts 
was made in Connecticut. Some of the places were in a 
very unsanitary condition ; others were reported irreproach- 
able ; all were equally healthy. 

A number of the jails were also inspected ; all were very 
filthy, but the inmates were in excellent health. At the State 
prison is a large open filth-pit, just outside the walls, which 
is infrequently cleaned and never disinfected ; the excreta 
of the prisoners is received in pails, and there are no flues 
whereby the cells are ventilated. There is veiy limited air- 
space, and the building is damp ; the walls and floors are wet 
from the condensation of moisture. "The health of the 
prisoners does not seem to suffer from these influences." 
" It appears to be true that the prisoners often have better 
health than before they were committed." 

The New York State Board of Health Reports give no 
less positive evidence of the harmlessness of filth. Newtown 
Creek and Hunter's Point, on Long Island,t are so foul that 
Mr. F. Law Olmsted smelled the odor from them as high 
as Forty-sixth Street, in New York City. Dr. Agnew smelled 

* Connecticut Board of Health Report, 1886. 

f Third Report New York State Board of Health. 



THE AIR. 95 

it at Madison Avenue ; in fact, the testimony proves that 
the stench spread its way from Fifteenth to Seventy-eighth 
Streets in the city of New York. Odors of putrescent animal 
matter, putrid fish, offal, fish-scrap, bone-boiling, common 
manures mixed with tarry smoke, kerosene smells, forming 
" a series of stenches that have acquired a magnitude that 
can hardly have been witnessed elsewhere in the world." 
The Fourth New York Board of Health Report says " the 
greatest of all stench nuisances is the creek itself;" its 
borders are crowded with nuisances. The governor is ap- 
pealed to because " the security of life and health, as well as 
the value of property in said town," is at stake. It is not 
claimed that any case of disease or any epidemic has ever 
arisen from these foul nuisances. 

The author has visited Hunter's Point many times ; has 
conversed with physicians who have practised there many 
years ; with druggists and citizens generally, to ascertain if 
disease, especially zymotic disease, prevails there more than 
elsewhere. The replies are singularly uniform, to the effect 
that none has ever been suspected to have arisen from this 
foulness. The citizens are aggrieved that such vile nui- 
sances exist, but they do not believe their health is impaired 
thereby. 

In the Fourth Report of the New York State Board of 
Health is an account of an investigation of the Glen Cove 
starch-factory at Sea Cliff. Two hundred and twenty-five 
people, mostly summer residents, signed a petition to the 
governor for its suppression. The petition said the foul 
stench and gases so permeated the atmosphere as at times 
to render respiration oppressive and produce nausea ; that 
they interfered with the enjoyment of Hfe and property, and 
caused great physical hurt; that they were prejudicial to the 
sick and destructive to the comfort of those in health. Dr. 
L. deposed that he and his family had suffered from nausea 
and sense of suffocation, and that the " aforesaid exhalations 



96 VAGARIES OF SANITARY SCIENCE. 

and the vast quantities of bacteria and other forms of germ 
life engendered by said refuse are exceedingly deleterious to 
health." Dr. F. deposed that a patient of his complained 
that the odors took away his appetite, and " in my estimation 
said exhalations are and must be deleterious to health." 
Mrs. D. affirmed that her hotel accommodates two hundred 
and fifty guests, besides transient visitors ; that they have 
frequently been compelled to leave the table on account of 
the stench, and that this renders the enjoyment of life and 
property uncomfortable. Dr. N. testified that the refuse 
kills the fish, and these decaying cause " a new and in- 
creased danger to the life and health of those inhabiting the 
vicinity ;" and, besides, the property is decreased in value, 
and the holders are harmed in health and in peace of 
mind. 

The permanent population at Sea Cliff is seven hundred ; 
in summer it is about four thousand. None of these affi- 
ants, doctors or others, specified any epidemic, or even a 
single case of disease, that had been caused by the starch- 
works. A weaker firm than the Glen Cove Company would 
probably have gone under ; but this concern did not propose 
to wind up its business without a struggle. Five hundred 
and thirteen, mostly permanent, residents and property- 
holders in and about Glen Cove testified that they had lived 
there and near the factory " for the period set opposite to 
our respective names," and that the charge that it is preju- 
dicial to health was, in their belief, " untrue and without any 
foundation of fact to support the same." Then followed 
special affidavits of people who had lived in Glen Cove from 
five to fifty years, who declared that they never knew or 
heard of any disease being caused by these odors ; and a 
large number of fishermen who had fished here from three 
to twenty years deposed that the refuse did not in any way 
affect clams, oysters, or fish ; that these were as plentiful and 
in as good condition as the same found anywhere. Five 



THE AIR. 97 

physicians of the place testified to its healthfulness, and to 
the harmlessness of the company's operations. 

At Lawrence and New Brighton similar nuisances exist, 
but no disease is reported from them. Cortland, Rhinebeck, 
Harrison, and Canajoharie are in an unsanitary condition, 
but no sickness reported. The stream that flows through 
Mt Vernon has been foul-smelling and disgusting for several 
years ; the health-officer says it '* cannot but be a source of 
disease ;" but no disease is reported. 

The Eighth Report of the New York State Board of Health 
narrates the sanitary inspection of Tivoli. Here the majority 
of the people use water from shallow wells ; the drains are 
so arranged that the sewage of one family is turned on to 
the premises of another, " any way to be rid of it for a 
time ;" two slaughter-houses are near the centre of the upper 
village ; ** one of the leading residents has his well below 
and within less than fifty feet of two pig-pens in a filthy 
condition, two privies ditto, and one barn ;" one well that 
supplies nine families is ten feet deep, and the water is so 
foul that the tenants ** don't think it healthy to use." No 
sickness is reported here. But with an unshaken trust in 
the filth pathology, the saintly reformer who reports on 
Tivoli sees in its health the interposition of the Divine 
hand, for he says, " There is, no doubt, a special Providence 
watching over these people, or they would not now be 
alive." 

The Ninth Report of the New York State Board of Health 
details the sanitary inspection of Tonawanda, Chatham, Fish- 
kill Landing, Matteawan, and Rye ; in these towns the soil 
and water were badly polluted, but the people were in good 
health. Rye was afflicted with great nuisances to sight and 
smell. From a very offensive pond here ice is cut. The 
death-rate of Rye that year is recorded as 10.75 P^^ thou- 
sand of population. The Pennsylvania Board of Health 
reports (1886) an inspection of the soldiers' orphans' home at 
E ^ 9 



98 VAGARIES OF SANITARY SCIENCE. 

Mercer ; it is overcrowded in every department ; the build- 
ings are badly located, privies in bad condition, clothing 
deficient, and much of it filthy. The " general health has 
not been bad ;" only two deaths the past year, one fi-om sun- 
stroke and one from croup ; the only one sick at time of 
inspection was " a boy with toothache." 

The foundation of the city of New Orleans is made by the 
debris of the Mississippi River ; its soil is like a sponge ; it 
has and can have no drainage. Dr. Holt, formerly presi- 
dent of the Louisiana Board of Health,* says that there is 
hardly a privy whose contents have not free access to the 
soil, to saturate the ground. Water ninety-five feet from the 
surface has yielded a large percentage of urea and organic 
matter. The soil is saturated with human excrement ; the 
people of New Orleans live on a dungheap, and it may be 
said that they have a privy in common. 

Dr. Joseph Jones says that the main drains and canals of 
New Orleans are blocked up with offal, presenting a green, 
seething, putrefying mass of filth, belching forth noxious 
vapors. Large numbers of the people sleep on the ground- 
floor of houses badly constructed, badly drained, situated 
on land which is saturated with water, which is the seepage 
from privies and foul drains. Dr. Jones writes to Mayor 
Shakespeare f that examination and measurement show that 
there is a mud deposit in all of the drainage-canals in New 
Orleans, varying in depth from four to eight feet. Fer- 
mentation and the evolution of foul gases are constantly 
going on in this immense mass of filth. " Every known 
and unknown combination and product of the putrefaction 
of vegetable and animal matter can be found in these foul 
reservoirs." On page 212 of the same book. Dr. Jones says 
one-third of those dying in New Orleans die in poverty 

* Sanitarian, vol. vii. 

f Louisiana Board of Health Report, 1880-83. 



THE AIR. 99 

and are buried at the public expense ; " one-sixth of those 
who die in New Orleans perish in silence and misery;" 
their deaths are certified to by the coroner. The general 
death-rate, white and colored, for the last four years has 
been 26.43, 25.02, 23.41, 23.92, an average of 25.19. The 
death-rate of the whites in those years was 23.59, 22.36, 
22.90, 21.27, ^^ average of 22.53. The general death-rate 
of New Orleans is greatly augmented by strangers, sailors, 
and laborers on the river. Dr. Jones says * the death-rate 
of the whites — exclusive of foreigners and strangers and 
laborers on the various lines of railroads, who crowd the 
hospitals and prisons — would not exceed fifteen per thou- 
sand of the inhabitants per annum. 

If we apply the sanitary touchstones to this city, — the 
proportions of zymotic and infant mortality to total number 
of deaths, — we find that for the four years ending 1889 the 
percentage of zymotic deaths to total mortality f in New 
Orleans was 15.04, 16.7, 16, 18.7, an average of 16.61. The 
percentage of infantile deaths, five years and under, to total 
mortality for the same years was thirty, thirty-two, twenty- 
nine, thirty-three, an average of thirty-one. The average 
number of those who died in public institutions yearly was 
twelve hundred and fifty-five for the four years ending 1889. 
In the same time four thousand one hundred and thirty-nine 
deaths were certified to by the coroner, a yearly average of 
one thousand and thirty-five. 

The city of Washington contains twelve thousand less 
people, white and colored, than New Orleans. It has an 
abundant supply of good water, it is well sewered, its streets 
are broad and kept scrupulously clean, its plumbing is care- 
fully supervised, it has sanitary regulations without number; 
its sanitary inspectors are in emblazoned uniform; to the 



* Louisiana Board of Health Report, 1882. 
f Louisiana Board of Health Report, 18S6-S9. 



ICX) VAGARIES OF SANITARY SCIENCE. 

observer it is the ideal of the sanitarian, in direct contrast 
to New Orleans. For the last twelve years the infant mor- 
tality of Washington has been forty per cent, of the total 
mortality. Its mean death-rate * for thirteen years has been 
23.88. The percentage of zymotic disease to total mortality 
for the four years ending 1889 was 19.9, 21.50, 22.19, 24, 
an average of 21.89, against that of 16.61 for New Orleans 
during the same time. 

That the general population of Washington is better sup- 
plied with the material comforts of Hfe than is that of New 
Orleans is plain to the most superficial observer. This is 
proved by the deaths in the public institutions and by those 
under the head of violence and neglect, which are probably 
coroner's cases. For the four years ending 1889 there died 
in the public institutions in Washington, including the gov- 
ernment hospital for the insane, where occur over a hun- 
dred deaths yearly, six hundred and ninety-seven, seven 
hundred and twenty-three, eight hundred and twenty-two, 
eight hundred and nineteen, an average of seven hundred 
and sixty-five. Under the head of violence and neglect 
there died in the same years two hundred and three, one 
hundred and eighty-nine, one hundred and sixty, one hun- 
dred and fifty-four, an average of one hundred and seventy- 
six. 

Dr. Hatch f reports on the sanitary condition of Sacra- 
mento : The drainage here is defective ; waste-water from 
kitchens is thrown on the surface; in the large majority of 
cases the privy is a mere hole dug in the ground ; when 
full, it is covered over and another is dug by its side ; per- 
colation from cesspools still further pollutes the soil. This, 
he says, has been going on in a low alluvial soil for twenty- 
eight years. The hotels and houses are so imperfectly 



* Board of Health Report, District of Columbia, 1889. 
t Board of Health Report, 1879-80. 



THE AIR. lOI 

plumbed that sewer-gas enters them. There is a slough 
but a few steps from the principal business street, which is 
daily and hourly befouled by filth. Dr. Hatch says, " Yet 
with these very evident defects, these violations of hygienic 
rules, the sanitary condition of the city is good and the 
death-rate by no means discouraging." That year, 1880, 
it was unusually high, — 19.7 per thousand, — but then the 
percentage of zymotic disease to total mortality was 14.6, and 
the percentage of infantile to total mortality was 24.7. The 
next year the death-rate in Sacramento fell to 18.2 per thou- 
sand. 

The New Hampshire Board of Health Report for 1891 
says that Carroll County jail, which was reported in 1889 as 
the worst in the State as regards sanitary condition, is in no 
sense a decent place for the detention of criminals. There 
are about three hundred and fifty inmates in the Hillsborough 
County almshouse ; in this institution there is no system of 
sewerage worthy the name, and the old vaults are always in 
an unsanitary condition. No sickness is reported at either 
of these establishments. The sanitary condition of Grafton 
County jail is the most abominable to be found in the State. 
" It would be difificult to devise a more filthy and disgusting 
arrangement than is here to be found." In one story " the 
cells are directly connected with the soil-pipes." "The 
sanitary condition of the entire institution is such as to 
jeopardize the health of all those living within its walls." 
" It is not to be wondered at that the jailer lost a son from 
typhoid fever." The board writes to the county commis- 
sioners that " a fatal case of diphtheria has recently occurred 
at the jail." The commissioners reply, " There has been no 
case of diphtheria at the jail." " There is no sickness 
amongst those confined at the jail." ** The jailer's son con- 
tracted typhoid fever elsewhere, and came home and died 
there." Here was an imported case of typhoid fever into an 
institution which was in the vilest " sanitary condition." 

9* 



102 VAGARIES OF SANITARY SCIENCE. 

The reputed causes, not only for the spread but for the gen- 
eration of that disease, were here in the greatest abundance. 
Yet we find no case occurring there but the imported one, 
and " no sickness amongst those confined at the jail." 

In Science, vol. x., 1887, Mr. William Glenn writes that 
the Back Basin at Baltimore is a nearly stagnant pond two 
hundred by five hundred yards. It receives the drainage 
of about eighty thousand people. In Back Basin are the 
sediments of this drainage. " Here they undergo fermenta- 
tion and decay, at times giving off odors offensive indeed." 
Mr. Glenn says he has been in quite constant communication 
with the workmen who dredge this sewage, and who pass 
their days stirring about it. " They live in an atmosphere 
loaded with offensive gases." "And what of their health? 
With singular unanimity they declare that the occupation is 
a healthy one." Among a hundred men engaged in that 
work he had not heard, for nearly three years, of any case 
of zymotic disease. Men, he says, engaged in this business 
ought to sicken and die. " Curiously enough, they do not, 
more than men in other occupations." Mr. Glenn says 
he has no knowledge of what filth-diseases are or are not, 
and he has no suggestions to offer; he simply states the 
facts. 

In the report * of the Board of Supervisors of San Fran- 
cisco on Chinatown, headed, " Startling report of the hideous 
and disgusting features of Chinatown," the board says, " In 
a sanitary point of view, Chinatown presents a singular 
anomaly. With the habits, manners, customs, and whole 
economy of life violating every accepted rule of hygiene ; 
with open cesspools, exhalations from water-closets, sinks, 
urinals, and sewers tainting the atmosphere with noxious 
vapors and stifling odors ; with people herded and packed 
in damp cellars, it is not to be denied that, as a whole, the 

* San Francisco Daily Report, July, 1885. 



THE AIR. 103 

general health of this locality compares more than favorably 
with other sections of the town, which are surrounded by 
far more favorable conditions." 

That portion of New York City which is bounded by 
Broadway, Fourteenth Street, and the East River contains 
about four hundred thousand people. There are streets in 
this district which are more densely inhabited than any 
other part of our globe, except portions of Naples and 
of the large cities of China. Here are the most filthy 
wharves, slips, streets, lanes, yards, houses, clothes, and 
persons to be found in the metropolis. When the inhabi- 
tants who live here bathe, they bathe in filthy water. Mr. 
Riis has told us about this part of New York in " How the 
other Half live." While the mass of the people in this 
quarter may be just as kind in their dealings with their 
fellow-beings, and as industrious as the masses are else- 
where, it is none the less true that this locality is the resting- 
place and abode of the most dissolute tramps of both sexes, 
and the lair of the most brutal loafers on the face of the 
earth. 

In 1889 the New York City Board of Health put forth a 
remarkable document. For convenience it divided the city 
mto six districts. The first, south of Fourteenth Street and 
east of Broadway ; the second, south of Fourteenth Street 
and west of Broadway ; the third and fourth extended north 
from Fourteenth Street on either side of Broadway to Fifty- 
ninth Street and Harlem River ; the fifth and sixth, north of 
Fifth-ninth Street to the end of the island and the Twenty- 
third and Twenty-fourth Wards. The death-rate for the 
city at large was 26.33 per thousand. The death-rate of the 
filthy and crowded district south of Fourteenth Street and 
east of Broadway was 22.55 per thousand. The third district, 
the next most crowded and filthy, had a death-rate of 22.10, 
against the death-rate at large of 26.33; and the highest 
death-rate in any of the filthy and crowded localities was 



104 



VAGARIES OF SANITARY SCIENCE. 



but 26.60, against 26.33, which was the death-rate at large 
for the city. 

There is probably — there must be — a gross error in this 
document. The author of this book does not pretend to be 
able to detect it. It is not the low birth-rate ; it may be in 
the large number of people in the first and third districts 
that are between the ages of fifteen and forty years. It is 
strange if the New York Health Board does not know 
better than any one unconnected with it where this error 
lies. If there be no error (which God forbid !) in the figures 
of the pamphlet we are considering, then the unblushing 
fact will not be conjured down, say what we will, that filth 
and overcrowding and intemperance and carelessness are 
more conducive to good health and a long life than are 
cleanliness, an abundance of fresh air, temperance, and 
prudence. 

The sanitarians were confounded at the results of their own 
reports, which pulverized their doctrine of the filth-genera- 
tion of disease. Resolute not to abandon it, for to do so 
involved their annihilation and put out of commission their 
boards of health, they proceeded to shift their ground, and 
the discovery of the microbe of disease momentarily afforded 
them a refuge. This, they said, unlocked the mysteries of 
Sanitary Science ; after all, it was not the filth that caused 
the disease ; it was the microbe that found in the filth the 
pabulum for its growth and the stimulus to its self-fecunda- 
tion. If the germ was absent, the filth was inert ; if the 
filth was destroyed, the germ withered and disappeared. 

Herein lay the essence of Sanitary Science ; and to pre- 
vent the disastrous conjunction of the germ and the filth 
the supreme efforts of the sanitarians should be directed. 
They made no investigations ; but the improvisations of 
amateurs, amatrices, and professors of Sanitary Science 
teemed with accounts of the antics of the newly-found germ 
in its beloved filth. Vain delusion ! 



THE AIR. 105 

By and by some scientific men investigated the behavior 
of the disease-germ in the presence of putridity and decay. 
M. Miquel * says he will prove, contrary to the opinion of 
many authors, that vapor from masses in putrefaction is 
micrographically pure ; that the gases proceeding from it are 
always free from bacteria ; that the air itself from putrefying 
meat, even in its intensest putrefaction, distended by gas and 
giving off an insupportable odor, far from being charged 
with microbes, is entirely pure, if it is in a certain condition 
of humidity. 

The cholera microbe, when tested by its discoverer, was 
found to speedily disappear in the presence of putrid bac- 
teria. Mixed with well-water, the cholera bacilli retained 
their vitality f thirty days ; in the Berlin canal, six to seven 
days ; mixed with faeces, twenty-seven hours ; and in the 
contents of cesspools they could not be demonstrated after 
twenty-four hours. Fliigge J says that the refuse of cattle- 
stalls, kitchen-water, and general filth are excellent condi- 
tions for the putrefactive bacteria, but " they are totally 
unsuitable for the growth of infective agents." " We see in 
all waste-waters, in putrid fluids, etc., that the facultative 
(disease) parasites, even when they are sown in enormous 
quantities, die in a few hours, or, at most, in a few days." 

In the Centralblatt fur Bakteriologie, vol. vi., 1889, Dr. 
Justyn Karlinski records his experiments with the typhoid 
bacillus in sewage. He put two hundred cubic centimetres 
of fresh typhoid stools in a quart of filth from a privy 
which was rich with bacteria ; the bacilli in the stools were 
small in proportion to those in the specimen from the privy. 
Forty-eight hours later not a typhoid bacillus could be 
found. Four times this experiment was tried, with the 
same result. He sterilized two hundred cubic centimetres 

* Les Organismes Vivants, 1883. 

f British Medical Journal ^ vol. i., 1 886. 

J Micro-organisms. 



I06 VAGARIES OF SANITARY SCIENCE. 

of sewer filth and mixed with it ten cubic centimetres of 
typhoid f^ces ; for a whole month he was able to detect 
typhoid bacilli, though in small numbers compared with 
those in the typhoid stools. In sixty different observations 
he found the contents of the sewers acid ; the lower strata 
of some privies were almost feebly alkaline. He put fifty 
cubic centimetres of typhoid stools, which had more than 
two thousand colonies of typhoid bacilli to each cubic cen- 
timetre, with fifty cubic centimetres of privy faeces, with 
alkaline reaction. After the whole was carefully mixed he 
could find only a single typhoid to four hundred and sixty 
strange bacteria ; after five days, not one in nine hundred ; 
after ten days, not one in three thousand. He repeated and 
varied these experiments, always with the result that the more 
water and the more filth, the sooner did the typhoid bacilli 
disappear. 

^'Je mehr Kanaljaiiche und wasser, je grosser die anzahl 
von Faulnissorganismen^ desto schneller gehen die sonst 
wider standfdhig en typhus bacillen, die mit den Dejekten in 
die Senkgruben gelangen, zu Grunde!' 



CHAPTER V. 
The Water. 



The tripod on which Sanitary Science rests — to wit, " pure 
air, pure water, and pure soil" — breaks down completely 
when we consider the second element of which it is com- 
posed. 

Regarding this, about the only point on which the sci- 
entists are agreed is that pure water is an ideal substance, 
that it does not and cannot exist in nature, and that waters 
differ only in degrees of impurity. So they have arbitrarily 



THE WATER. IO7 

laid down certain formulae, and have classified waters as 
Pure, Usable, Suspicious, Impure, according as these were 
found to contain a less or greater amount of foreign mat- 
ter ; and, based solely on chemical analysis, there is a wide 
divergence of opinion about what constitutes a safe or a 
dangerous water for domestic uses. 

The satisfaction which the sanitarians derived from the 
anxiety and distress they had caused about the air we 
breathed was transposed into a riotous joy as they beheld 
the pangs they awakened after they had thoroughly aroused 
our suspicions about the water we were drinking. If they 
succeeded in having one condemned and rejected which 
was abundant, clear and sparkling to the eye, and grateful 
to the taste, and which the experience of a century had 
pronounced wholesome. Sanitary Science had made a " gi- 
gantic stride." They delighted to tell us that the brilliancy 
and stimulating taste of a water were perhaps the tokens of 
its impurity, and that such water might contain unspeakable 
filth. Our only safety lay in making it insipid by boiling. 
After it was boiled we added ice to relieve its tastelessness, 
and for a while went along in perfect security, when Sani- 
tary Science made another " gigantic stride" and discovered 
that the ice was contaminated. Boiling the water, to be 
sure, would destroy the morbific principle ; but freezing it, 
instead of removing impurities, actually concentrated them 
and made them more dangerous, and the disease microbe 
that lurked therein was none the less active and virulent. 
The very prismatic glow of the ice was the sign of danger. 
We had safely passed Scylla, but had gone to pieces on 
Charybdis. We were ready to sink in despair, when the 
countenance of the gracious sanitarian assumed a more be- 
nignant aspect as with outstretched arms he told us of the 
inexhaustible resources of Sanitary Science, which he was 
ready to invoke for the safety of ourselves and our families. 
He would inspect the ice. 



I08 VAGARIES OF SANITARY SCIENCE. 

The sanitarians teach us * that pure water, or water that 
is pure enough for potable use, should contain less than six 
grains of solids to a gallon ; there should be no indications 
of nitrites ; the amount of nitrates and free ammonia should 
be slight ; and of albuminoid ammonia there should be less 
than 0.0035 grain per gallon. It should be colorless, odor- 
less, and tasteless. 

Without tiring the reader with technical descriptions of 
the gradations of " Usable" and *' Suspicious" water, it is 
said to be " Impure" if there is decided smell or taste ; if 
it has over fifty grains per gallon of solids, and over four 
grains of destructible organic matter, with nitrates, nitrites, 
and ammonia to any great extent. It is conceded, however, 
that ten times this amount of these identical solids, with 
nitrates, nitrites, and ammonia mixed with our food, would 
be harmless, nor is it claimed that any artificial fluid con- 
taining this amount of proscribed solids, nitrates, and am- 
monia would have the least effect to produce disease. 

Sanitary literature is overrunning with " behefs" and 
"opinions" about the different diseases which are caused 
by drinking-water. All forms of malarial fevers have been 
ascribed to it ; also yellow, typhoid, and scarlet fevers, eiy- 
sipelas, diphtheria, cholera, dyspepsia, boils, goitre, ulcers, 
elephantiasis, diseases of the bones, diarrhoea, dysentery, 
calculi, bronchial catarrh, and the entozoic diseases. The 
statements, however, respecting its agency in the production 
of disease are so conflicting that Parkes f says, " The exact 
connection between impure water and disease does not 
stand on so precise an experimental basis as might be 
wished;" but he adds, "Apart from actual evidence, we 
are entitled to conclude that abundant and good water is a 
prime sanitary necessity." When we consider the devout 
"belief" of the EngUsh sanitarians regarding the infective 

* Parkes, Hygiene. f Hygiene. 



THE WATER. IO9 

power of what they say is impure water, these admissions 
of Parkes, who seems to have carefully weighed the evi- 
dence, are all the more striking. The most acute German 
observers have never found any relation of water to disease. 
To use the words of the Massachusetts Board of Health, 
" The idea is essentially English." 

It is extremely doubtful whether there is any scientific 
proof that the water of any spring, well, pond, lake, or 
stream, which has been in use as potable water, ever caused 
in the human system a specific disease, or anything more 
than slight or temporary disorder, unless such water was 
contaminated, deliberately or accidentally, by some irritant 
poison. Marsh-water is accused of causing malaria ; but 
Professor Colin * cites portions of Italy and Algiers where 
marsh-water is drunk and no malaria follows. Marsh-water 
is largely drunk in Holland and Hungary, but it does not 
produce malaria. Surgeon-General Lawson says that in 
Florida, where it was used by the United States troops, 
malaria was less severe than in those military departments 
where the water-supply was from other sources. 

In 1 88 1 the work of draining Lake Okeechobee, in 
Florida, was commenced. Colonel J. M. Kreamer, the en- 
gineer, testifies that during its progress, extending over a 
period of four years, more than five hundred men were 
employed, — whites, — most of them unacclimated. They 
labored in the swamps summer and winter, a good deal of 
the time immersed to their waists ; they drank no other than 
marsh-water. Colonel Kreamer declares that during these 
years not a single case of malarial disease occurred among 
them. He says he conferred with medical men in advance, 
who counselled him regarding prophylactics ; that he sup- 
plied himself with them, but had no occasion for their use. 
It was prophesied that after these swamps were drained 

* Parkes. 
10 



no VAGARIES OF SANITARY SCIENCE. 

malarial disease would occur, but in a letter, dated May 2, 
1 89 1, Colonel Kreamer says, "Residents living on the re- 
claimed lands are exempt from chills and fever. Settlers on 
these lands, who suffered from chills and fever annually in 
Kansas, have had no recurrence from this malady since 
locating in Florida ;" yet during all of these years they have 
continued to drink marsh- water. Rohe '^ says that, in his 
opinion, " the instances in which malarial fevers are due to 
drinking-water are very rare." 

The most puzzling, and at the same time the most ridicu- 
lous, disagreement exists among analysts of water. Dr. 
F. L. Phipson f says we possess no positive data whereby to 
condemn a sample of drinking-water, and cannot possess 
such data until physiological experiments have been made 
to prove when and why a given kind of water is bad or 
good. Our text-books for the last thirty years — EngHsh 
and foreign — have stated when the total impurities of a water 
should condemn it, but this is a mere assertion that has 
been copied from one book to another. Mr. Charles Ekin,J 
F.C.S., on Water Analysis, says, " A fair trial of the different 
processes leads to the conclusion that all are absolutely 
worthless, so far as distinguishing between organic matter 
that is innoxious is concerned." "As giving any indication 
of the wholesomeness of a water they are useless." Fox § 
relates that the water of the same well being analyzed by 
five different chemists of repute, the first opines that the 
water is of good quality ; the second, that it is surface-water 
and is bad; the third, that it contains so much organic 
matter as to be unfit for drinking ; the fourth, that it is a 
perfectly pure water; the fifth, that it is unusually pure. 
Fox tells also (p. 179) of two waters from neighboring 

* Hygiene, 1891. 

f Chemical News, 1879. 

\ Journal Franklin Institute, 1 880. 

\ Sanitary Examination of Water. 



THE WATER. Ill 

pumps which were examined by a health officer ; one was 
pronounced pure and the other quite unfit for use. He says 
the confidence of the people was somewhat shaken in their 
health officer when it was discovered that ''both pumps 
derived their water from one and the same well." Mr. 
Reuben Haines * says, " The most diverse opinions have 
occasionally been expressed in regard to the wholesomeness 
of the water-supply of a city by chemists of established 
reputation." 

Dr. J. A. Tanner, t in a lecture on water-analysis, gives a 
table of the analyses of twenty specimens of artificially- 
prepared waters containing sewage from different sources, 
dejecta from typhoid fever, and black-vomit from yellow- 
fever patients. Three of these samples were pronounced 
good by the three different processes of examination, — the 
combustion, the ammonia, and the permanganate. Eight 
of the twenty specimens were condemned, while in nine 
there was no agreement. Lake Drummond, which has 
always been in high repute among sea-captains for long 
voyages, and thereby proved beyond a doubt to be good, 
was pronounced by the three methods " impure," " foul," 
*' impure." Dr. Tanner says, " Viewing the subject impar- 
tially, it seems we must conclude that such examinations are 
as apt to condemn a good water as they are to commend it, 
and to commend an impure water when they should condemn 
it ; and that we know of no chemical method by which the 
ethereal-like substance causing disease when in water can be 
recognized at present. We are at sea, with an unreliable 
compass to guide us." Professor Mallet % says it is not pos- 
sible to decide on the wholesomeness of a water by the use 
of any of the processes of examination for organic matter. 



'^ Journal Franklin Institute, 1882. 

•^ Sanitarian, 1888. 

X National Board of Health Report, 1882. 



112 VAGARIES OF SANITARY SCIENCE. 

Dr. C. G. Currier * says chemistry " affords us no sufficient 
test of the freedom of a water from the infectious principles 
which cause serious disease or which lessen the sum-total 
of the vital forces." In a report on the sanitary examina- 
tion of potable waters, Mr. Elwyn Waller f concludes that, 
in reviewing the methods of water-analysis, our knowledge 
of the whole matter falls very short of what is desirable. 
" The means of determining, even approximately, the safety 
of a water are at present extremely crude and unsatis- 
factory." 

Dr. Mace J says that chemical analysis furnishes little 
information respecting the character of a water, and often 
none at all. The inferior beings that breed and feed on 
azotized matters in water do no harm. 

The bacteriological examinations of water give no more 
satisfactory results. Dr. Link § showed that " the attempt 
to put forward bacteriological examination as a decisive 
criterion for the character of a water is devoid of a satis- 
factory basis." Dr. E. K. Dunham 1| concludes "that the 
bacteriological examination of water cannot, save under 
exceptional circumstances, pronounce a direct verdict as to 
the sanitary value of that water." Dr. T. M. Prudden \ 
says, *' It is already known that in some cases the results of 
chemical and biological analyses do not coincide." Louis 
Parkes ** says, " Chemical analysis is powerless to deal with 
those cases of infinitesimal pollution of a pure water." 
" Cultivation tests are equally powerless to cope with such 
cases." Though chemical analysis can in the majority of 
cases determine the amount of organic pollution, *' there is 
no possibility of ascertaining whether the water thus pol- 
luted is potent for evil, or whether it may not be entirely 



* Ameriean Journal Medical Sciences. f Ibid., 1883, 

% Annales d'Hygiene, 1888. \ Chemical News, 1886. 

11 Medical Record, 1889. f Ibid., 1887. ** Practitioner, 1887. 



THE WATER. II3 

harmless." " The only way of ascertaining the probable 
effects on the human system of drinking such water is for 
the operator to perform the experiment on his own person." 
C. E. Cassal* says that " in the present state of knowledge no 
chemical analysis would justify the assertion that a water was 
likely to cause a particular disease," and" no process of exam- 
ination whatever" will prove the noxious character of a water. 
" The counting of micro-organisms in some hands, even 
those of eminent persons, yields results which are wholly 
ludicrous." C. E. Pellew f says, with our present knowledge 
a satisfactory microscopic examination of water is " hardly 
possible, even for one thoroughly skilled in such investiga- 
tion," and " the question of the purity or impurity of a water 
cannot be satisfactorily settled by bacteriological tests 
alone." Yet with these humiliating confessions, publicly 
made, in the one hand, the sanitarians in official capacity— r 
and with an impudence which passes all comprehension — 
continue to offer with the other their farcical analyses of 
water, which are often made at the general expense, and 
solemnly parade them before the people as if they possessed 
a scientific value. On the strength of these analyses they 
have not only destroyed many valuable public water-sup- 
plies, but they have arbitrarily invaded the premises of 
private citizens, and ordered the closure of wells which have 
been proved by scores of years of experience to be healthful 
water-supplies. 

We are forced to the conclusion that there are no better 
tests for drinking-water than our first parents possessed ; and 
that the instincts, taste, and experience of a committee of 
farmers, mechanics, or intelligent housewives are more to be 
depended on in the selection of a public water-supply than 
are the so-called scientific tests of the sanitarians. 



* British Medical Journal, November 5, 1891. 
f Manual of Practical and Physical Chemistry, 1892. 
h 10* 



114 VAGARIES OF SANITARY SCIENCE. 

There is no better way to ascertain the effect of so-called 
polluted water on the human system than by studying its 
influence on individuals and on large bodies of people. 
Emerich * drank for fourteen days from one to two pints of 
sewer-water which was disgusting to the eye, and which 
chemical analysis showed was highly polluted ; it contained 
refuse of blisters from human skin, pieces of salad, animal 
hairs, particles of excrement, and much other non-appe- 
tizing material. {Nicht gerade appetitliche Dinge mit sich) 
He drank this water while he was suffering from intestinal 
catarrh, and it had no unfavorable influence on the disease. 
Again, when he had a severe gastro-enteritis, though the 
disease had its course, it subsided while he continued to 
drink it. He gave the same to two of his patients (with 
their consent) who were suffering from diseases of the di- 
gestive organs ; the diseases were not aggravated. 

A large part — seven-eighths — of the people of London 
are supplied with water from the Thames and Lea. Only 
since 1852 has the law compelled the companies to filter it. 
It is declared that filtering is not competent to relieve it of 
its dangerous organic impurities. 

The sanitary literature of England is afire with accounts 
of the pollution of the drinking-water of London. In 1867 f 
Professor Frankland reports that it has received great quan- 
tities of putrescent matter; some of it is totally unfit for 
domestic use. In 1869 there is unquestioned evidence that 
the water is infected with animal matter; in 1870 it is ex- 
cessively nasty as to taste and smell, and the health of 
seamen and others on shipboard is in danger. In 1872 it is 
in a very filthy condition. In 1 874 the water of one of the 
companies is so nasty that it resembles "pea-soup." In 
1875 seven out of eight companies in London are furnishing 
water from pestilent sources. It is still bad in 1882, and a 

* Handbuch der Hygeine. f London Lancet, 



THE WATER, II5 

new idea is brought out ; Sanitary Science has made another 
"gigantic stride;" the chief danger from a water is now 
not from its usual, but its accidental, pollution. In 1885 * 
" it is difficult to keep from despair" on account of the dis- 
gusting pollution of the Thames. " It is a cesspool through- 
out its tidal regions," and in 1887 the Thames is in a 
" horrible and dangerous condition," and in the winter " it 
is fouler than ever." This year " the owners of house-boats, 
steam-launches, and other craft drain their sewage into the 
chief drinking-water supply of London." 

Mr. G. Phillips Bevan f at a meeting of the " Ballooii 
Society," in a lecture on the Thames and public health, said 
that instead of getting rid of our sewage, "it is churned 
backwards and forwards on us every day." When the 
essay was ended, a resolution was unanimously passed, 
" that in the opinion of this meeting the system adopted by 
the people of Kingston, Richmond, and adjoining districts, 
of drinking the water into which they put their sewage, is 
filthy, foul, and abominable, and barbarous in the extreme, 
and calls loudly for an immediate remedy." Dr. G. Vivian 
Poore,J President of the Section on Sanitary Science, at the 
twelfth meeting of the Sanitary Institute, stated that the 
public was becoming alive to the fact that causes which 
poisoned the surface-wells of London were equally poison- 
ing the Thames and the other sources of London water. 
" No thinking being could feel easy about the London 
water-supply." For it is impossible for the Thames to be 
pure. The whole of the sewage of all towns between 
Gloucester and London was emptied into it, and the great- 
est portion was drunk by the inhabitants of the metropolis. 
The Medical Press § says, " For years the condition of the 
Thames and Lea in every way proved the unfitness of these 



* London Lancet. f Builder, August 2, 18S4. 

\ Sanitary Record^ 1890. \ April, 1S91. 



Il6 VAGARIES OF SANITARY SCIENCE. 

rivers for drinking by the people of London," and Dr. Blax- 
all reports in the same journal (May, 1891), that the Thames 
drinking-water is fouled by excrementitious matter. 

A most remarkable coincidence, that during these forty 
years that the millions of people in London have been 
drinking this polluted water, the death-rate has never per- 
manently increased, and since 1880 has steadily declined, 
and especially from the class of diseases that polluted water 
is said to generate. 

London must have lost its sense of humor entirely, for 
there is no record that the town burst out laughing when 
it read in the Medical Times and Gazette of July 27, 1867, 
"It is notorious that just during the months when the or- 
ganic constituents of Thames water are at their highest, 
diarrhoea is at its lowest ; and vice versa!' In the Chemical 
News^ Professor Tidy, in his report to the society of 
medical officers of health, says, " I have diligently com- 
pared and considered the death-rates, and also, as far as 
possible, the causes of death, in different parts of the metrop- 
olis supplied by the Thames water, the Lea, and the water 
from the chalk-wells of the Kent Company, respectively. 
I have failed to discover any difference worth noting in the 
death-rate, or any evidence whatever that any special class 
of diseases has been prevalent from drinking the water of 
the Thames and Lea, or absent from the use of chalk-water ; 
indeed, what difference there exists is in favor of the Thames 
and Lea waters over that of the chalk-wells." Professor 
Tidy t says that in 1879 the water in the Thames showed a 
larger amount of organic matter on account of floods ; " yet, 
notwithstanding this, the death-rate in London for 1879 i^ 
the lowest on record." Professor Tidy says that while he 
admitted that disease might have been produced by impure 
or polluted water, it is seen from an examination of statis- 



* 1878. f Chemical News y 1880. 



THE WATER, l\y 

tics that the death-rate of towns in which water is obtained 
from wells is practically identical with that in towns sup- 
plied by rivers ; and that in London, as regards mortality, 
there is very little to choose between districts with the water 
from the chalk-wells and those supplied by river-water. In 
the Chemical News, 1883, Messrs. Crookes, OdUng, and 
Tidy say, " Taking a series of years, and relying solely 
upon the water analyses supplied to the Registrar-General, 
it does with singular perversity happen that the years in 
which the metropolitan rate of mortality is exceptionally 
high are the years in which the proportion of organic im- 
purities in the water is relatively low ; while the years in 
which the metropolitan rate of mortality is exceptionally 
low are the years in which the proportion of organic im- 
purities in the water is relatively high." In the years 
1869-70-71, in each of which there was the exceptionally 
high rate of mortality of over twenty-four per thousand, the 
mean proportion of organic impurity in the Thames water 
was represented by nine hundred and twelve ; while in 
1872-80-81, in each of which there was the exceptionally 
low rate of mortality of considerably less than twenty-two 
per thousand, the mean proportion of organic impurity in 
the Thames was represented by the number eleven hundred 
and seventy-one; the proportion in 1868, with its mortality 
of 23.5, being represented by the number one thousand. 

M. Hueppe, in a report* to the International Hygienic 
Congress at Vienna, said that after comparing the figures 
of morbidite and mortality by typhoid fever and cholera in 
cities provided with eau potable and sufficient sewerage, with 
those from cities not so provided, it was impossible to de- 
cide oui ou non whether drinking-water had any influence on 
the propagation of contagious diseases. 

In 1839 the city of Boston petitioned the General Court 

* Annales d' Hygiene. 



Il8 VAGARIES OF SANITARY SCIENCE. 

for power * to introduce water. Though no positive cases 
of disease were adduced as having been caused by the use 
of native water, notwithstanding its proverbially bad repu- 
tation, the physicians of the town seemed to concur that the 
introduction of a plentiful supply of pure soft water would 
be a good thing for the public health. In i844,t Dr. Walter 
Channing made a plea for pure water in Boston. He says 
it is not pure now and is unfit for use ; it is insufficient in 
quantity, and great inconvenience and danger are the re- 
sults. " An abundant supply," he adds, " promotes health 
and longevity and as surely tends to diminish or prevent 
pauperism." In Boston, previous to 1848,^ wells and privies 
were about equally numerous and in close proximity ; but 
the suppression of wells had Httle to do in lessening typhoid 
fever. " Our Lowell correspondent speaks of a well used 
by at least a hundred families, containing fifty-two grains 
of inorganic matter and twenty-five grains of organic resi- 
due to the gallon ; and yet the people using it seem to be 
even less liable to typhoid fever than those using water 
of a better quality." "Old Boston previous to 1848 was 
riddled with wells and privies side by side, all over its 
limited and very crowded territory. The water must have 
been continually charged with the products of decompo- 
sition." The report says here is a test on a grand scale. 
" There is a diminution of typhoid fever, but in no striking 
degree." 

In the eighth report of the Massachusetts Board of 
Health is an account of an investigation into the causes of 
diphtheria in Gloucester in 1876-77. The wells were sus- 
pected and the waters of thirty-four of them were examined. 
They were so filthy that Professor Nichols, who analyzed 
them, exclaimed, with surprise, " Do people actually drink 



* Boston Medical and Surgical Journal, 1839. f Ibid. 

% Second Report Massachusetts Board of Health. 



THE WATER. IIQ 

these waters ?" The ammonia in them varied from 0.0037 
to 2.35 ; the albuminoid ammonia from 0.0040 to 0.0723 ; 
inorganic residue from 3.20 to 198.9; organic residue from 
0.6 to 10.7; total solid residue from 3.48 to 205.4; chlorine 
from 0.70 to 55.04 in 100,000 parts. 

The professor says that no one of these waters is fit for 
drinking, and some show evidences of very great pollution. 
To eighteen of them, it is distinctly said, no illness could be 
referred. In a house supplied by one there has been much 
illness, " a large part of which, however, can be traced to 
very wet cellars and inability to provide the comforts of 
life." In seven households there had been illness where the 
water had been used from seven of these wells ; of the re- 
mainder, no mention is made of their having caused sick- 
ness. " Of the worst specimens (Nos. 22 and 6), both as 
valuable for manure as the sewage taken from the Pittsfield 
sewers. No. 22 is from a well which has been dug for a 
century and used by three families, who are always well." 
" A family of robust children, types of health, have been 
brought up on No. 6, without any illness that could be 
fairly traced to the use of the water." " As regards diph- 
theria in connection with these thirty-four specimens of 
water, the worst cases occurred where the best water 
was used." The conclusion arrived at was that the water 
did not cause the epidemic of diphtheria in Gloucester in 

" The thirty-four samples of well-water probably repre- 
sent fairly the wells used for drinking purposes in Glouces- 
ter." " No. 7 is worth twice as much for manure as ordinary 
sewage," but " the use of the water has not been shown to 
have caused any illness." 

The condition of fifteen wells that were near cemeteries 
in different parts of Massachusetts is detailed in the sixth 
report of the Massachusetts Board of Health. Five of 
these had drains and privies within fifty feet; they were 



120 VAGARIES OF SANITARY SCIENCE. 

from thirty to forty, and one was a hundred years old. Of 
none was there any mistrust that the water had caused dis- 
ease. Only one of the fifteen was suspected. These waters 
when analyzed showed great pollution, — chlorine as high as 
13.20 in 100,000 parts, and total solids as high as 138.60. 
It will be remembered that both the well- and pubHc-supply 
of Newport, also its ice, were grossly polluted ; yet the 
death-rate was not augmented thereby. 

In 1 88 1 Boston's water was examined by Professor Edes, 
who said, " It contains pollution seventy per cent, above the 
limit of health ;" he found it " abounding in decomposing 
organic matter." Some of it, Dr. Barnes says, was the color 
of good coffee. In the tank in his own house, Dr. Barnes 
found a mud deposit three-fourths of an inch deep, that was 
very offensive when removed. Dr. Minot considered "the 
water-supply of Boston a disgrace to the city, and a source 
of danger to the health of the community." Professor 
Leeds, who examined the water of towns on the Hudson 
and elsewhere, said that Boston's supply was the worst of 
all, and was " absolutely dangerous." Dr. Bowditch had to 
give up drinking it, or bathing in it, without filtration. Yet 
the Massachusetts Board of Health * say, " For months a 
very large portion of the water-supply of the city was 
wholly unfit for any household use." It adds, " Nor does 
the use of this water appear to have had a noticeable effect 
upon the death-rate of the city or upon the health of the 
inhabitants." If we seek for something more than this gen- 
eral avowal in the vital statistics of Boston, we find that the 
average annual proportion of zymotic to total mortality in 
that city for the preceding ten years was 28.40 per cent. ; 
and the proportion of infant to total mortality for the same 
time was 40.75 per cent. ; while during the year that the 
three hundred and fifty thousand people of Boston were 



[S81. 



THE WATER. 121 

drinking water polluted seventy per cent, above the healthy 
standard, "abounding in decomposing organic matter," 
"absolutely dangerous," and "wholly unfit for any house- 
hold use," the proportion of zymotic mortahty declined to 
26.87, and the infant mortality (a still more sensitive test) 
declined to 36.75 per cent. 

It must not be forgotten that if any citizen of Boston had 
possessed a well supplying such water, the Board of Health 
would have forcibly entered his premises and closed it. If 
he had resisted the invasion he would have been arrested, 
fined, and imprisoned as an enemy of the public health. 

The National Board of Health * reports on the sanitary 
condition of Baltimore. Though pumps have been mostly 
discarded in that city, yet water from them is used in the 
first district on two hundred premises. The report adds, 
" The comparative immunity of the people from disease 
under the most trying sanitary conditions is extremely 
remarkable, but should not lead us to the conclusion that 
filth and bad water are conducive to health." Seven families 
used water from an old pump which must have been pol- 
luted by a privy ; but, in spite of this, " no sickness or 
death" had occurred /or a year. At another point, eight, 
at another, four, and at another, three families were all using 
" bad" or " very bad" water from wells, close to privies in 
bad condition ; yet the inspectors could not find that a single 
case of disease, except one of consumption, had occurred 
for a twelvemonth in any of these families. 

In the Connecticut Board of Health Report for 1885 is a 
paper by Dr. Wolfe on " Sanitary Examination of Drinking- 
Water." The Bridgeport water is polluted by animal and 
vegetable matter ; New Haven's water is polluted by vege- 
table decomposition. The supply of Hartford coming from 
Brandy Brook is so contaminated that it is unfit for public 

* 1880. 

F II 



122 VAGARIES OF SANITARY SCIENCE. 

use. The people of Hartford are drinking the drainage 
from one of the filthiest swamps in New England. Such a 
water is a " vera causa of diarrhoea, dysentery, and malarious 
diseases." New Britain's supply is similar to that of Hart- 
ford. Yet that year, in the same book, Hartford reports, in 
" Health of Towns," malaria as decreasing, and makes no 
mention of diarrhoea and dysentery ; New Britain makes a 
similar report ; in New Haven the malaria is less than the 
average, and dysentery here in an epidemic form had not 
been known for thirty years. 

Surgeon McKee, U.S.A., reports * that the water in the 
tank at the garrison in San Francisco, which contains twenty- 
seven thousand gallons, and which was supposed to be 
secure from pollution, had for some weeks a bad odor and a 
sickening, nauseous taste. An investigation disclosed that 
a polecat had crawled into the tank through the overflow- 
pipe and had been drowned. The carcass was in an ad- 
vanced stage of decomposition, and must have been there 
some months, for fragments of the rotting body were float- 
ing in all directions. The water had been drunk by eighty 
people, — men, women, and children. Dr. McKee looked 
for the development of some " filth-disease," but no serious 
results followed. After the tank was cleaned some persons 
complained of " a sense of goneness" and a loss of appetite ! 
The doctor says this occurrence is opposed to the theory 
that diseases originate in filth ; and he asks, " Might not this 
have been almost too acute and overpowering to have at- 
tained a lodgement, when a milder poison would have been 
more insinuating and permanent ?" , 

In the seventh report of the New York State Board of 
Health is the story of the Jamestown water. It is supplied 
partly by driven- wells and partly from the outlet of Chau- 
tauqua Lake, which is contaminated by sewage. The board 

* New York Medical Journal, November 3, 1883. 



THE WATER. 1 2$ 

reports that it is " a menace, and one affecting the life and 
health of the inhabitants." Of seven samples taken in 
December, 1886, all were grossly polluted. Nine affidavits 
declared that Jamestown's water was unfit for use ; five of 
these were made by doctors. One physician testified that 
he had seen it " loaded with decaying and putrid animal and 
vegetable matters," and that it was offensive to sight and 
smell. Many other citizens say it is not acceptable to the 
community. Only one physician attributes any disease to 
its use. 

The water company had a good deal of property at stake, 
and they made a gallant fight to protect it. Seven physi- 
cians swear that since the introduction of this water there 
has been a less amount of zymotic disease, and that it has 
not and does not endanger the security of life and health 
where it is used. Mr. Hall swears that he never heard or 
knew of any disease, illness, or death caused by it ; others 
testify to the same effect. Statistics of deaths which oc- 
curred at Jamestown before and after its use are shown, 
which prove the diminution of zymotic ailments. The 
water- works were established in 1882. 

In 1883 there were 11 deaths from typhoid fever. 

" 1884 " " 3 " " «« « 

" 1885 " " 2 " « « « 

«« 1886 " « o « to August 15. 

In 1883 there were 4 deaths from scarlet fever. 

" 1884 " " 2 " «* *' " 

" 1885 " " I " " " '< 

" i886 " " o " " " « 

The records of vital statistics and other evidence showed 
that " while the city has been rapidly increasing in popu- 
lation, the number of deaths from this class of (zymotic) 
diseases has been no less rapidly diminishing." 



124 VAGARIES OF SANITARY SCIENCE. 

A sanitary inspection of the city of Allegheny in 1885* 
found the water-supply grossly polluted by slaughter-houses, 
bone-boiling and soap-factories, besides " six sewers were 
found discharging their noisome contents, under the burning 
September sun, directly into the river above the mouth of 
the influent-pipe." There are also piles of garbage '' fester- 
ing on the river-bank." " The committee returned from this 
tour filled with amazement at the fact that with all these 
multiplied and horrible sources of pollution, the water sup- 
plied the city of Allegheny should, except when thick during 
freshets, be a not unpalatable and, so far as indicated by the 
average low rate of mortality in the city, a not unwholesome 
beverage." 

In an official report,t Elwyn Waller, chemist, of New 
York City, says of the Croton water that it has a bad taste 
and odor, described as filthy ; a green-grass color ; and, on 
standing, a green-grass scum rises to the surface. The cause 
was attributed to decomposing fish, sewage, and other 
poisonous material. Although it continued in this filthy 
state for six weeks, no cases of illness were assigned to it. 
The same condition was present in 1859, i^ 1^73* ^^<^ ^^ 
1874. When these impurities were most abundant and 
most unpleasant to eye and taste, the water was not un- 
wholesome. 

The waters of sixty other places in different parts of the 
country were examined ; all of them stank and were dis- 
agreeable to the taste and disgusting to the eye, and the 
odor was described as " fishy," " woody," " like cucumbers," 
** like dead fish," " musty." One had the odor of a horse- 
pond, three were distinctly classed of a pig-sty odor, and 
some had the smell of putrid fish. The bottoms of some 
of the reservoirs were filled with decaying stumps and veg- 
etables. This state was present generally in summer, and 

* Pennsylvania Board of Health Report, 1885. f i^^'- 



THE WATER. 12$ 

lasted from six weeks to five months. In some of these 
places the water was so filthy that it had to be abandoned. 
Here were sixty cities, with populations varying from five 
thousand to one million two hundred thousand, drinking 
this filthy water, which is classed as " impure" and *' dan- 
gerous" by the sanitarians ; yet this report concludes that 
the filthy conditions of these waters " never as yet proved 
deleterious to the health of any community where they have 
occurred, as far as any records go." 

Dr. Griffin * says, " Several years ago a former incumbent 
of the Department of Health caused to be removed all 
pumps from the city, in the hope that the number of cases 
of typhoid annually occurring would be diminished. It has 
been supposed that the saturated soil had polluted the water, 
and that the drinking from the wells and pumps during the 
warm summer weather was in a great measure responsible for 
the increasing number of typhoid cases which made their 
appearance in the fall. Their removal, however, has not 
exercised any apparent effect in diminishing the number of 
those attacked, as the average has remained about the same 
during a series of years after, as before, this sanitary im- 
provement.^* (Italics ours.) 

Bouchardat f says the well-waters of old cities like Paris 
contain the products of organic decomposition, and, besides, 
organic matter incompletely decomposed. They are so dis- 
agreeable that they cannot be used as potable waters ; but 
the bakers and brewers use them, and pretend that they 
favor panification and the fabrication of beer. In spite of 
the repugnance one feels at their use, he says, " No fact has 
come to his knowledge to prove that they are noxious." Bou- 
chardat, in his " Conclusions," p. 197, designates as potable 
waters all of those natural waters which are agreeable to 
drink ; and declares that the only way to pronounce on their 

* Report of Brooklyn Board of Health, 1889. f Trait6 d' Hygiene. 

II* 



126 VAGARIES OF SANITARY SCIENCE. 

salubrity is to observe their effect on the health of people 
who have long used them. 

The history of the Croton water-supply and its relation 
to the public health of New York is without a parallel in 
the pages of sanitary literature. In 1885 it received * the 
drainage of 20,000 persons, 1879 dwellings, 602 barns, 9453 
cows, 1224 horses, 1501 pigs, and, besides, grist-, saw-, and 
cider-mills, condensed-milk factories, cemeteries, and slaugh- 
ter-houses drained into it. During freshets, which often 
overflow the river-banks, " all privy-vaults within that range 
are overflowed and washed out" into the stream. In 1888 
it was shown that 25,000 people and 33,000 domestic ani- 
mals drain into this supply, besides the drainage from the 
roads. The cemeteries add to the danger. The editor of 
the Sanitarian says, ** The subsoil currents which penetrate 
the coffins take up everything that is soluble during the 
process of putrefaction and convey it into the water-courses 
at all seasons." " What," he asks, " are the sixty-two deaths 
of the Park Place disaster, in comparison with the daily 
stream of disease and death among the million and a half 
of people of the city consequent upon neglect to protect the 
water-supply ?" ^'The recent chemical analyses have startled 
the City Board of Health by the discovery of nitrites, — the 
indubitable evidence of animal putref action'' Then follow 
more italics. " The putrefaction of human dead bodies on 
the Croton Valley water-shed sufficiently accounts for the 
presence of nitrites in the water, independent of the other 
six thousand one hundred and forty-six special nuisances 
and the surface filth of thirty-three thousand domestic 
animals." 

" Will the people of New York be longer content to 
drink such an infusion ?" 

A special inspection made by the Board of Health in 

*5amV<j!rza«, September, 1 89 1. 



THE WATER, 1 2/ 

August, 1 89 1, showed that the Croton water was grossly 
polluted by stables, privies, kitchen-drains, saloons, cess- 
pools, factories, and pig-pens. Chemical analysis showed that 
"all of 'the water, therefore, below Harlem is contaminated." 
The danger was so imminent that the pulpit took up the 
cry. " Whence this poisoned water ?" exclaimed the Rev. 
Dr. Dixon in a sermon. The city was threatened with an 
epidemic of diphtheria ; it had already broken out in his 
own congregation. " The water-supply of the city has been 
declared by experts to be unfit for human use. To let this 
fountain of Hfe become a pool of filth marks the outermost 
limits of the pendulum of social degradation." The official 
report in the newspapers had the heading, " No wonder 
zymotic diseases prevail !" We seek in the vital statistics 
of New York City for the effect of this poisoned water. 
More than one million six hundred thousand people were 
drinking it. The culmination of filthiness and danger was 
reached in the summer of 1891. Throughout the perform- 
ance of this comedy, the solemnity of the New York Board 
of Health never relaxed for a moment. Without a blush, 
or a word of explanation, it issued reports for the thirteen 
weeks ending September 12, 1891, showing that the number 
of deaths 

From diphtheria was 281 

" typhoid fever was 107 

" diarrhoeal diseases was 2527 

" malarial diseases was 66 

The average number of deaths for the corresponding 
weeks for the previous ten years 

From diphtheria was 392.1 

" typhoid fever was 1 20.7 

" diarrhoeal diseases was 3373-9 

" malarial fevers was 1 24.0 

Sanitary Science had condemned this water; it had re- 
cevied the censures of the press and the maledictions of the 



128 VA G ARIES OF S ANITA R Y SCIENCE. 

clergy ; yet, in New York City, zymotic disease had steadily 
declined since i885,and during the last summer was the lowest 
on record, and then the decline was notable in those particular 
diseases of that class which the sanitarians say are especially 
caused by such water as the people were drinking. After 
their terror had been raised to the highest pitch respecting 
the drinking-water, the Board of Health began to relax 
its rigors and to soothe their fears. As the acme of the 
paroxysm from which the patient was suffering had been 
attained by successive steps, so the antidote must be ap- 
plied in graduated doses. From day to day the condition 
of the water was reported in the papers ; it was now a little 
better ; again there was a slight relapse ; but, on the whole, 
a steady improvement was announced, and soon notice was 
served on the people that it was safe to drink the water,— ^ 
the nitrites had disappeared. It was not claimed that a 
single one of the dreadful sources of pollution had been 
removed ; the dead bodies were continually accumulating in 
the graveyards ; ** the subsoil currents which penetrate the 
coffins and take up everything that is soluble during the 
process of putrefaction" were still flowing into the water- 
supply of New York City ; it was still taking the overflow 
of privies, drains, stables, kitchens, and saloons. But the 
people were told that the Board of Health were hard at 
work examining this water; they were evaporating it to 
dryness ; they were redissolving the remaining solids ; they 
were distilling it in alembics ; they were torturing it with 
reagents in test-tubes ; they were straining their eyes peering 
at it through microscopes. And now, as if the mockery was 
not quite complete, about one month after the proclamation 
that the water had become purified, typhoid fever broke out 
in New York City to such an extent that it was little short 
of an epidemic. " Dr. Edson * said there had not been so 

* New York Sun, September 22, 189 1. 



THE WATER. 1 29 

many cases of typhoid fever in the city since 1889, when 
there was a small epidemic." 

We must search for the cause of this fever. It is not in 
the water, for that has been undefiled for a whole month. 
We must probe deeper. It happened, fortunately, that the 
New York Board of Health contained a sanitarian of pro- 
digious discernment. He sounded the depths of Sanitary 
Science to divine the cause of this fever. We read in the 
New York Sun of September 22, 189 1, "One reason why 
there is so much of the disease about just now is, according 
to Dr. Edson, that boys go in bathing off the docks near 
where the sewers empty into the river." The people of 
New York, lay and professional, seem to have received this 
solution of the mystery with infantine docility, and we will 
not presume to call it in question. Presuming that the 
essays on contaminated water will be as copious in the 
future as they have been in the past, let us hope that some 
enlightened sanitarian will condescend to explain how boys 
going in bathing off the dock can cause an epidemic of 
typhoid fever among adult men and women. 

The Connecticut Board of Health reports (Second Re- 
port) that in that State ice is, in many instances, cut from 
polluted ponds ; *' but no cases of disease were traced to 
the ice." 

The New York State Board of Health for 1886 says that 
Onondaga Lake receives daily twenty-five million gallons 
of sewage from Syracuse. This lake is a great ice-field. 
Biologically, all of the specimens of water and ice taken 
from this lake were ranked as " unsafe waters for potable 
purposes." But no evidence is offered to show that it had 
ever caused any disease. The Pittsfield ice-field * is con- 
taminated by refuse from dwellings and two factories. The 
water-closets of one of these, which are used by one hun- 

* Seventh Report Massachusetts Board of Health. 



130 VAGARIES OF SANITARY SCIENCE. 

dred and fifty persons, empty into the lake, from which ice 
is cut. " The water is sometimes foul in appearance." One 
specimen contained ammonia 0.0140 and albuminoid am- 
monia 0.0348 to each gallon. No disease is reported from 
the use of the ice. 

In Popular Science Monthly, vol. xxxii., Dr. Prudden says 
a considerable quantity of Hudson River ice is cut just 
below Albany, where the stream is so contaminated as to 
be absolutely filthy ; typhoid here occurs frequently while 
ice-cutting is going on ; and " the complacency with which 
we swallow the frozen filth affords a spectacle of self-abase- 
ment as melancholy as it is disgusting." 

In Medical Record, 1887, Dr. Prudden says that most of 
the ice for New York and Brooklyn is cut on the Hudson 
River between Troy and Poughkeepsie. Troy empties 
daily eight million gallons of sewage into the Hudson, 
already charged with contributions from Cohoes and Lan- 
singburg, to say nothing of the impurities which the Mohawk 
brings down. Albany furnishes millions of gallons daily of 
sewage ; and the river takes the refuse of thirty thousand 
inhabitants of Hudson, Catskill, and Kingston besides. The 
Hudson River ice, '* thoroughly contaminated with sewage 
at the upper part of the ice-fields," is further defiled by 
smaller towns on its borders. The two bacterial diseases — 
blood-poisoning and typhoid fever — are almost constantly 
present in Albany. Dr. Prudden is informed that "there 
is no systematic disinfection of the typhoid discharges, which, 
therefore, enter the sewers with their myriads of bacteria in 
a living condition." 

Here, he says, they proliferate for an indefinite period, so 
long as sewage is present. They will live in ice for at least 
one hundred and three days, perhaps longer ; and when 
thawed out, they go on proliferating just as they did before 
being frozen. On this river are cut three million tons of 
ice, supplying not far from three million people. The ordi- 



THE WATER, I3I 

nary number of bacteria is so great that a glass of melted 
ice would contain five hundred thousand, which is forty 
times as many as are allowed for wholesome water. Dr. 
Prudden estimates that the excreta of at least fifty typhoid 
patients pass directly into the river from Albany between 
December and March. At one point, where twenty-five 
thousand tons of ice are stored, the water shows from twenty 
thousand to fifty thousand bacteria per cubic centimetre. 

The masterly presentment of this indictment against the 
Hudson River ice, and the adroit manner with which it has 
been surrounded with a plexus of circumstantial evidence, 
seem to render its conviction sure. At the critical moment, 
however, Dr. Prudden surprises us by allowing it to slip 
through his fingers through an alibi which the elder Mr. 
Weller would have rejoiced to obtain as an adornment for 
his extempore discourses on criminal jurisprudence. 

He examined one hundred and fifty-three specimens of 
Hudson River ice. *' It will naturally be asked," he says, 
**if typhoid baciUi have ever been detected in the ice? 
They have not," he replies. Further, although it contains 
staphylococcus, pyogenes, its application to wounds does not 
produce blood-poisoning. He anticipates that " those call- 
ing themselves somewhat ostentatiously common-sense peo- 
ple" may apply the " ancestor or experience argument," to 
show that there is no danger. 

It is to the bar of common sense and experience that 
test-tube and microscope must come at last for final judg- 
ment. As soon as common-sense people have recovered 
from their consternation about " swallowing the frozen 
filth," they will ask why the typhoid fever bacilli were not 
found in any of the one hundred and fifty-three specimens, 
if they are poured out of Albany and Troy in the manner 
described, and go on proliferating so long as there is sewage, 
and are not destroyed by the freezing process ? They will 
ask why, if this ice is continually receiving an increased 



132 VAGARIES OF SANITARY SCIENCE. 

amount of typhoid poison, and the consumption of the ice 
is increasing enormously every year, should the cases of 
fever be steadily declining in number ? The free consump- 
tion of ice begins about the middle of April, attains its 
height by the middle of June, and drops off in September. 
As soon as they are over their fright, common-sense people 
will ask why it is that when the most of this '' frozen filth" 
holding the typhoid poison is consumed, fever is compara- 
tively rare ; and why it is that it is nearly always rife — when 
it occurs at all — some six weeks after the great consump- 
tion of ice has ceased. Common-sense people want to 
know if the law in Sanitary Science is invariable that two 
and two make five, and if the less contains the greater? 
They will ask why the thousands of people who navigate 
this river in canal-boats and other vessels just in the months 
when typhoid fever is usually at its height, and who take 
their drinking-water from it, are much less subject to the 
disease than those not so exposed ? They may go a step 
further and inquire if the cause of true science would not be 
better served and the general welfare promoted if scientific 
men, instead of exciting panics in the public mind, were to 
exert themselves to allay unnecessary fears of the people. 

In the next volume (p. 32) of the Medical Record is a Paris 
letter which relates that Dr. Thoinet " had made laborious 
researches to discover the t}'phoid bacillus in the foul water 
of the Seine, but found that the pure water of the Vanne 
contains the bacilli in much larger numbers ;" and that M. 
Pouchet, in a paper read before the Academy of Medicine, 
says, *' The growth of the typhoid bacillus is arrested in 
media rich with organic matter, whatever be its nature." 
" It is preserved and developed much better in clean than in 
foul water." 

The Massachusetts Board of Health * (1889) reports an 

* Report, 18S9. 



THE WATER. 1 33 

investigation into the ice-supplies of that State. Thirty- 
places reported ice taken from polluted sources. The third 
question which was put by the board to its correspondents 
was, " Could any cases of illness be assigned to the polluted 
ice ?" The answers to this question were, " No." 

Dr. A. W. Nichols reports an outbreak of sickness at 
Rye Beach, which was ascribed to ice. This was partaken 
of by five hundred individuals : twenty-six manifested 
" grave, continued, and characteristic symptoms" of intes- 
tinal irritation, diarrhoea, nausea, giddiness, etc. The sick- 
ness was confined to one hotel ; another, an eighth of a mile 
away, and the neighboring cottages, escaped. The milk, 
water, food, and sewerage in the invaded hotel were excel- 
lent ; and suspicion fell on the ice, which had been cut from 
a pond that received sawdust and other refuse. The report 
does not say whether the other hotel and the cottages were 
supplied with the same ice, or whether the hotel where the 
sickness occurred had obtained its ice from the like source 
years before ; neither does it say how long those who were 
attacked had been using it previous to their seizure. 

The report makes this statement, — a remarkable one, truly, 
when we consider how susceptible children are to intestinal 
irritants, — " It is worthy of remark that no person under the 
age of ten years was known to be affected by the impure 
ice." The analysis of the water in the pond showed that it 
was not as impure as many waters that people habitually 
drink. The symptoms and course of the disease proved 
that it was non-specific. It resembled more those myste- 
rious and, as yet, unexplained seizures which in various 
countries have followed the ingestion of certain animal foods. 
But so much noise had been made about ice, with no results 
whatever, that the reformers grasped this occurrence and 
hailed it as a triumph of Sanitary Science. 

Overwhelmed by evidence of their own collecting that 
the waters which they had classified as " filthy," " impure," 

12 



134 VAGARIES OF SANITARY SCIENCE. 

and " dangerous" had no power to impair in any way the 
health of the millions who had consumed them for gener- 
ations, the sanitarians sought to extricate themselves from 
the dilemma by the aid of the germ. As usual, they made 
no researches, but they displayed their powers of improv- 
isation to a degree that had before this had no parallel. 
After all, they said, it was not the filthy water that caused 
the disease ; it was the germ that found in filthy water, as in 
putrid solids, its habitat and its subsistence. 

In the Chemical News * is recorded a series of brilliant 
experiments by Messrs. Crookes, Odling, and Tidy, to as- 
certain the necessary conditions for the existence and prop- 
agation of morbific microbes purposely introduced into 
water. The results were in accordance with the conclusions 
of other investigators, — namely, that in the struggle for ex- 
istence, " the microbe forms proper to running water out- 
grow and starve out the introduced morbific forms." These 
experiments were made with the anthrax bacilli. It was 
found that their existence in the unfiltered water of the 
Thames was so brief as to be practically without danger, 
while in sterilized water they retained their vitality longer 
than in any other. In the intermediate conditions between 
unfiltered and sterilized, the duration of their existence was 
in proportion to the purity of the water. As has been seen 
on a previous page, the experiments of Thoinet and Pouchet 
with the typhoid bacillus corroborate those of Crooks, Od- 
ling, and Tidy. 

Jules Arnould,t after reviewing the labors of the bac- 
teriologists to ascertain the power of the different microbes 
to penetrate the soil and defile water, concludes : ist. That 
bacteria of any kind pass with difficulty through the earth, 
even if it be permeable, either from above downwards or 



* Vol. liv., 1886. 

t " L'Eau et les Bacteries," Revue d' Hygiene. 



THE WATER. 1 35 

horizontally. 2d. That water, as it presents itself in nature, 
even if rich in organic matters, is antipathique to pathogenic 
bacteria. 

A few months later, Kraus * recorded his experiments 
with the typhoid, cholera, and anthrax bacilli. He criticises 
the methods of Meade-Bolton and others, who, in their 
experiments with pathogenic bacteria, sowed these in ster- 
ilized water at a temperature of from 68° to 71°, and even 
96° F., a condition in which drinking-water is never found. 
In his experiments Kraus took three samples of water at 
a temperature of 51° F. The typhoid bacilli disappeared 
more rapidly in the more filthy specimens; and as soon as 
the water bacteria appeared in perceptible numbers the 
former were destroyed, so that after five days they were no 
longer to be found. The second day the cholera bacilli 
could not be seen, and the anthrax had disappeared by the 
third. Although the pathogenic bacteria at the beginning 
of the experiments were from one to two thousand times 
more numerous than the water bacteria, the latter soon got 
the advantage and overcame the former. The experiments 
proved that there could be no development of any of these 
three forms of pathogenic bacteria in water of the temper- 
ature at which it is generally used for drinking, but rather 
a speedy destruction ; yet, in spite of the low temperature, 
the ordinary water bacteria proliferated rapidly. Indeed, 
Bolton's experiments had shown that the tendency of the 
pathogenic bacteria, even in water at from 68° to 72° F., 
was to diminish and not to increase. 

In the Archiv fur Hygiene, 1890, Dr. Justin Karlinski 
records his observations with the typhoid bacillus in water 
as the result of a series of experiments no less brilliant and 
convincing than those of Crookes, Odling, and Tidy, and 
Kraus with the anthrax and other bacilli. 

* Archiv. fur Hygilne, 1SS7. 



136 VAGARIES OF SANITARY SCIENCE, 

Dr. Karlinski found that just in proportion to the filthi- 
ness of the water and the number of putrefactive bacteria 
was the existence of the typhoid bacillus curtailed ; that in 
extremely filthy water, holding large amounts of chlorine 
and nitrates and rich in common bacteria, the typhoid baciUi 
began to disappear rapidly in one hour after they were 
added, and at the end of forty-eight hours were no longer to 
be seen. In water that was comparatively free from organic 
pollution and putrefactive germs, they were to be found for 
twelve days ; but here, from the moment that the water- 
bacteria got the upper hand, the typhoid bacilli disappeared 
completely from the water. 

Fliigge * says, " We see in all waste-waters, in putrid 
fluids, etc., that the facultative (disease) parasites, even when 
they are sown in enormous quantities, die in a few hours, or, 
at most, in a few days." To insure their growth all other 
germs must be carefully put out of the way, and the patho- 
genic bacteria must be maintained at a temperature of 72°. 
He adds, " Typhoid bacilli have never yet been demon- 
strated outside the human body except Pfeffer's demonstra- 
tion of their presence in the dejecta of typhoid patients." 
" Nor," says Fliigge, " can any of the pathogenic bacteria 
multiply in water even where the temperature is favorable, 
because they absolutely require a certain though small 
quantity of the best nutritive material." On the other hand, 
he says they retain their vitality in sterilized water a com- 
paratively long time ; but in unsterilized it has been proved 
that they rapidly disappear, and he declares that " patho- 
genic bacteria have never yet been demonstrated with abso- 
lute certainty in any water, unless they have been purposely 
sown therein." 

The thorough and exhaustive experiments of Dr. Valletf 

* Micro-organisms. 

f Le Bacille Coli-Communis. 



THE WATER. 1 37 

with the typhoid bacillus in privy contents show the impossi- 
bility of contaminating wells with it through the contiguity of 
privies. Every one of these experiments with the typhoid 
bacillus showed that it not only could not multiply in privy 
contents, but that it speedily died when mixed with them. 

There have been two outbreaks of typhoid fever in this 
country which have confirmed the behef in the minds of 
many medical men that this disease may be communicated 
by drinking-water. The first is related by Dr. Flint, and 
occurred at North Boston, New York, nearly fifty years ago. 
At the time Dr. Flint did not regard the water as the cause 
of the epidemic, though later he seems to have accepted 
this view. It is supposed that every one who was seized in 
this epidemic drank the suspected water. 

In 1843 3. passenger in a stage-coach arrived at North 
Boston, and, on account of illness, could proceed no further. 
He died at the tavern a few days later of typhoid fever. Be- 
fore this outbreak the disease was unknown in that neighbor- 
hood. Twenty-three days after the arrival of the stranger, 
some members of the tavern-keeper's family were taken sick 
with typhoid fever ; other cases soon followed ; in a month 
more than one-half of the population, twenty-eight persons, 
had been afflicted, and ten died. Only one family escaped ; 
and that one, owing to a quarrel, did not use the suspected 
water. Dr. Flint, at the time, attributed the exemption of 
this family to non-intercourse with the others. To make 
the chain of water-contamination complete, he says,* 
" Within a few years I have learned from a physician re- 
siding at the time of the epidemic in the neighborhood, that 
a privy used in common was in close proximity to the 
well." A remarkable feat of mnemonics ; for most physi- 
cians would be likely to forget the particular location of a 
privy in the course of two-score years ! 

* 1880. 
12* 



138 VAGARIES OF SANITARY SCIENCE. 

The rehearsal of the North Boston legend has so often 
quickened the awe of the neophyte, and strengthened the 
faith of the devotee, of Sanitary Science, that we desire to 
approach the subject with a proper degree of reverence. 
But there were some circumstances about this epidemic 
which awake scepticism. It did not reach its height until 
the end of a month. One after another was seized, between 
October 14 and December 7, so that, though all took the 
water simultaneously, there was an important difference of 
time in the seizure of the first and the last case. We must 
suppose a wide range for the incubative process, or else that 
the water was not uniformly affected. We must also believe 
that the typhoid germ — which is so sensitive that in the lab- 
oratory, in order to keep it alive and to induce it to multiply, 
it must have the cleanest quarters and the daintiest food, 
must be coddled at a temperature not below 75° F., and 
which has always shown such an aversion for bad company 
that it would refuse to perform its usual functions in its 
presence — on this occasion preserved its integrity immersed 
in the contents of a privy, and travelled with them to a 
somewhat distant well, so that in ten days it was competent 
to infect people who drank the water. 

The disease began to decline without any abandonment 
of the use of the water. It may be justly said that all of 
the people in North Boston who were susceptible to the 
disease had been attacked, and that the fire went out for 
want of fuel. But here was a roadside well — an appurte- 
nance of a tavern — whose water, very likely, was every day 
partaken of by as many people as were seized by the fever 
at the hamlet. The tavern was the stopping-place of the 
stage-coach ; it was natural that travellers in wagons (there 
was no railroad there then), on horseback, and on foot 
should refresh themselves with this water, not only during 
the time it was poisoning the people in North Boston, but 
for months afterwards. There is no record that any of these 



THE WATER. 1 39 

travellers were seized, and that they in their turn infected 
other unregenerate privies, which later infected other blame- 
less wells, which again infected other people. 

Is it not quite as consonant with reason to consider that 
the cause of the epidemic at North Boston, like hundreds of 
other circumscribed outbreaks of typhoid fever, is unknown ? 

The other epidemic occurred in Plymouth, Pennsylvania, 
in 1885. The story bids fair to become a sanitary classic. 
Four cities and one society sent committees of medical men 
to investigate the cause. All arrived at the conclusion * 
that the cause was to be found in the contamination of the 
mountain-stream by the typhoid excreta of a patient. This 
had been poured on the ground, had been frozen, and sud- 
denly thawed out about the last of March, and washed into 
this stream. It was admitted that no proliferation of the 
typhoid germs went on before the thaw, on account of tem- 
perature; therefore none penetrated the ground. This 
mountain-stream, which came leaping down over rocks, was 
proved by a number of analyses to be as perfectly pure as 
water could be ; absolutely free from sediment or organic 
matter. So it was necessary to abandon temporarily the 
theory which had been proclaimed by the sanitarians, that 
the typhoid bacillus must have organic matter in decompo- 
sition, sewage, to subsist on or it would die. From April 
12 to May 16, between one thousand and twelve hundred 
persons were seized, out of a population of eight thousand. 

Here, also, we are obliged to admit a difference of from 
twelve to forty-nine days in the incubative period of differ- 
ent persons for the first one thousand or twelve hundred 
cases, or to assume that there was no uniformity in the 
water. A very large majority of the cases used the moun- 
tain-stream water, though, unlike the North Boston epidemic, 
quite a respectable number were seized who drank other 

*Dr. Davis, Medical Record, vol. i., 1885. 



I40 VAGARIES OF SANITARY SCIENCE. 

water than the mountain-supply. If the cause of these cases 
was ever investigated, it was never reported. One house on 
Franklin Street * contained two patients, one of whom was 
a school-girl whose school was supplied with the mountain- 
water ; but it is not reported whether this girl drank of it 
between the last of March and the date of her seizure. Dr. 
Taylor says that many cases exist where well-water is used ; 
but it is found that the patients first attacked are those 
accustomed to drink hydrant-water away from home. It is 
not stated, however, whether any of these had drank it away 
from home, subsequently to the last of March and before 
their seizure. Again, different streets supplied by the same 
water were differently affected. Ackley Street, Dr. Taylor 
said, had but few sick, while Franklin Street had a great 
many. This is accounted for by the fact that Ackley Street 
is supplied by a smaller pipe, and Franklin Street by one of 
the mains ! 

The most remarkable fact of all is that the typhoid 
bacillus was not even looked for in the water. The works 
were thoroughly overhauled by the water-company, but 
the epidemic continued through the summer and into the 
autumn. This is explained by the germs getting into the 
privies, and through them defiling the wells from which 
the people drank. This throws us back upon the original 
theory, — that the typhoid bacillus must have sewage to 
subsist on; and now we must believe that during April and 
May it was so delicate as to require perfectly pure water at 
a low temperature in which to proHferate; while in the 
summer it parted with its chastity, and was ready to carry 
on the nefarious work in company with the vulgar bacteria 
of the privies ! The mean temperature at Wilkesbarre f for 
the twelve days between March 30 and April 12 was 34°, 



* Medical News, May 16, 1885. 
t Dr. F. B. Hodge. 



THE WATER. I4I 

48°, 44°, 40°, 50^ 32°, 42°, 38°, 43^ 41°, 29°, 33°, omitting 
fractions. The temperature on the mountain must have 
been lower, and it is not unfair to assume that of the water 
coming- down over the snow to have been not much above 
32°. We leave it to the bacteriologists if it was possible for 
the typhoid bacillus to proliferate, or even to live, in such 
water. 

Dr. Torrey dared to call in question the "mountain- 
stream" theory of the epidemic, and was sharply reproved 
by the press. This goaded him to investigate the subject 
more thoroughly, and he says that every step confirmed the 
conviction in his mind that the mountain-stream theory is 
both "inadequate and misleading." He hints that Dr. 
Taylor's report was " instigated" by the Plymouth Water- 
Company, which, having supplemented its mountain-supply 
with the dirty Susquehanna, had been threatened with legal 
proceedings to invalidate its charter, and was strongly inter- 
ested in having the blame for the epidemic laid on the care- 
less disposal of the typhoid-fever patients' excreta. Dr. 
Torrey does not absolve altogether the mountain-supply, 
but recognizes three other factors, — the filthy river-water, 
impure air, and contaminated milk. 

If either water was at fault, the experiments of Thoinet, 
Pouchet, Kraus, Karlinski, Fliigge, and others with the 
typhoid bacillus would favor the mountain-stream theory; 
these having shown that the purer the water, the longer is 
the life of the typhoid-fever germ. The acceptance of their 
experiments as truths, however, overturns all previous 
fables, — and they are numbered by thousands,- — of typhoid 
fever being caused by dirty water, or by wells contaminated 
by privies. 



142 VAGARIES OF SANITARY SCIENCE. 

CHAPTER VI. 
The Soil. 

If we continue to decompose the trinity on which the 
established faith of the sanitarians is grounded, and to ana- 
lyze its third element, we find that what they call an impure 
soil is no more competent to produce disease than what they 
call an impure air or an impure water. 

From the beginning of the sanitary excitement great stress 
has been laid on the foulness of the soil. The reformers 
said this filth had been accumulating for centuries, wherever 
people had congregated in cities and towns. Privies and 
cesspools had corrupted the earth to an indefinite and un- 
limited extent ; it was saturated with the elements of disease, 
an overcharged volcano ready to burst forth at any moment 
and sweep us into eternity. 

Beneath, as above the ground, was a continual circulation 
of air ; this air, poisoned by the filth, was changed into me- 
phitic gases, which were drawn into our cellars, and, sucked 
through floor and ceiling, they permeated our bedrooms and 
infected us while we slumbered and slept. For long years 
people went tremblingly to bed, oppressed with these terrors. 
In winter the danger was tenfold, and our wives and children 
were in the greatest peril. It was of no avail for some who 
were not paralyzed by fright to try to assuage these fears by 
calling attention to the difficulty of securing atmospheric 
currents above ground, and to the improbability that air 
confined between particles of earth could acquire power and 
velocity, which the most acute inventors could not obtain 
on the surface, in order to ventilate our dwellings. 

The sanitarians said the warm-air ascending currents made 



THE SOIL. 143 

our houses so many chimneys, sucking out the ground-air* 
contaminated with decaying organic matter which was in the 
soil and with the germs of specific disease. 

If the ground-air in cellars is impure,t it gives rise to 
typhoid fever, diarrhoea, dysentery, cholera infantum, diph- 
theria, sore throats, and " numberless conditions of ill health 
which cannot be described under any particular name." 
CesspoUs, filthy vaults,! and filth in any form afford a fertile 
soil for the reproduction of the typhoid-fever germs ; and 
the " gases generated in these vaults are also loaded with the 
same germs, and rise into the air to be inhaled, or to pass 
by underground currents into the neighboring cellars, where 
they are sucked as in a chimney, to poison the air of the 
whole house. Whatever theory we hold, we come back 
necessarily to filth, decomposing organic matter, as the 
agency in the production of disease." 

The Connecticut Board in 1883 reported an epidemic of 
typhoid fever at Waterbury, that was due " to the saturation 
of the soil" with filth ; and it had before informed us that 
the typhoid-fever germ retained in the earth its vitality and 
infective power " for several years at least." Professor Linds- 
ley, on " Sanitary and Unsanitary Conditions of Soil," says, 
" The stagnant air, contaminated with the gases of decay 
from the filth with which the ground is overcharged, is 
sucked through the cellars of houses, and house-poisoning 
is the result. Where else can go the noxious gases ?" 

In the town of Malone,§ " the filth from privies and cess- 
pools is now contaminating the ground-air about the dwell- 
ings ;" this circulates freely, passing into the cellars and 
rising into the houses. " The warm-air ascending currents 



* Fifth New York State Board of Health Report, 
f Massachusetts Board of Health Report, iSSi. 
% Connecticut Board of Health Report, 18S3. 
\ Fifth New York State Board of Health Report. 



144 VAGARIES OF SANITARY SCIENCE. 

make the houses so many chimneys sucking out the ground- 
air." No sickness, however, is reported at Malone. 

Throughout the reports of the New York State Board, 
dismal accounts are given of the filthy condition of the 
ground in that State ; this suffices as a reason for any un- 
common sickness in any town, for when no other cause is 
apparent, the statement is usually made, " it (the sickness) 
is probably due to saturation of the soil with filth." 

Dr. Ezra Hunt * says, " Foul air, foul water, and foul de- 
compositions come from the ground-air ;" and if we were to 
take four feet of the city soil, with its overladen decomposition, 
and compare it with that of the open country, we would at 
once detect manifold differences in sickness and mortality, 
and we would not wonder that sanitarians call it " typhoid 
ripe." And before the same association,t Dr. A. B. Segur 
says, " The amount of ground-soakage in old towns has 
hopelessly contaminated our soil ;" and he wants the associa- 
tion to declare " that typhoid fever, cholera, and yellow fever 
are fecal diseases ;" as if a proclamation of this kind would 
be binding on the medical profession. 

It should be kept in mind that none of these sanitarians, 
who declaimed so loudly about the dangerous condition of 
the soil, pretended that they had made any investigations to 
sustain their oratory. Yet this improvisation not only im- 
posed on the mass of the people, it actually influenced the 
medical profession. Neither the public nor the profession 
could conceive that these men, who were posing as sanitary 
reformers, scientists, educating the people, as they said, 
could have the effrontery to intrude on them such trumpery 
as scientific facts without ever having made the slightest 
research. 

If Lemuel Gulliver, " first a surgeon, then a captain of 

* Proceedings American Public Healtli Association, 1874-75. 
t 1875-76. 



THE SOIL. 145 

several ships," after his return from Liliput and Brobdingnag, 
had set forth his claims as a learned traveller and anthro- 
pologist, on account of his labors in those countries, he 
would have been as much entitled to recognition as a scien- 
tist as were the hnprovvisatori who displayed their capriccios 
and fantasias as Sanitary Science. 

They never offered a jot of evidence to prove their asser- 
tions about the soil. There was none to offer except such as 
practical men could afford, who had labored in and observed 
the earth, in their mechanical and building operations. These 
called us to witness that the contents of a privy or cesspool 
never penetrated the earth beyond a few inches ; that the 
organic matter soon formed a stratum on the inner wall of 
either, which was impervious to air or water even in a loose 
sandy soil ; that less than one foot outside of this stratum 
the ground was as sweet to the senses as that under the snows 
of Mont Blanc. 

But in the excitement and frenzy of sanitary reform people 
were in no condition to take the evidence of their senses. 
If any man was so intrepid or so uncautious as to call for 
proof of the declarations of the sanitarians, or for the exer- 
cise of common sense in investigating them, he was stig- 
matized as an enemy of the public health. 

To arrest the destruction of life arising from soil-pollu- 
tion, sanitary codes were made more stringent, inspectors 
appointed, prosecutions commenced, and the sanitarians 
mounted the witness-stand and told judge and jury that they 
were Sanitary Experts ; and swore, *' So help them God," that 
the polluted soil contained " mephitic gases ;" that these 
generated disease and the germs of disease, and that the 
people were in jeopardy thereby. On this evidence, the 
judge ex cathedra anathematized the enemies of the public 
health ; the jury never failed to convict ; sometimes it gave 
its decisions without leaving the box. 

No ! says the reader ; out of zeal for the new-born science, 

G k 13 



146 VAGARIES OF SANITARY SCIENCE. 

and maybe inspired by vanity on account of the importance 
its apostleship conferred, these professors might, on the 
platforms and in their journals, exaggerate and magnify its 
principles ; but they would surely stop short of the witness- 
stand, and would not hurt their innocent fellow-citizens by 
swearing on them not only damages but contempt ; before 
they did this, they certainly must have investigated the soil 
by careful experiment, and have found the " mephitic gases" 
and the germ. 

Let the incredulous reader be assured that they did nothing 
of the kind ; neither in the fugitive pieces nor in the chefs- 
a'ceuvre of these Eminent Sanitarians can any evidence be 
found that they ever undertook any investigations, nor any 
trace of knowledge that any one else had ever made any 
inquiries respecting the nature or condition of the soil. 

By and by some scientific men directed their attention to 
the subject and published the result. Fodor * tested the air 
from four places, — from a spot in the University court at 
Klausenberg, sixty feet from a privy ; from the University 
cellar twelve feet below the surface, and from the court of 
the hospital, where the well was thirty feet from a privy. The 
fourth specimen was taken from the top of a mountain. The 
only difference in the air from the soil in these various places 
and elsewhere was in the large amount of carbonic acid and 
the deficiency of oxygen. The average amount of carbonic 
acid six feet below the surface, on the mountain-top, was 
greater than that at the same depth in the cellar of the Uni- 
versity or in the hospital-yard. He found that the earth 
which is richest in carbonic acid is freest from organic matter, 
and that the quantity of this acid is no criterion of the clean- 
liness of earth. Sulphuretted hydrogen was not to be found 
in the ground-air in Klausenberg, and the " mephitic" gases 
are not mentioned. Dr. Beutzen's experiments led to similar 



[875. 



THE SOIL. 147 

conclusions. He says it is doubtful whether the carbonic 
acid in the soil comes from the humus or from other pollution ; 
that if the soil be defiled the carbonic acid does not fix the 
pollution ; that no one can determine the sanitary condition 
of a place, or its likelihood to have disease, by the quantity 
of carbonic acid or the analysis of the organic matter. Other 
examinations in Europe had practically the same results. 

In 1876 Professor R. W. Nichols dug a pit six feet square 
and five and a half feet deep in Back Bay district in Boston. 
He filled it within a foot and a half of the top with semi- 
liquid from a sewer man-hole and covered it with earth. 
Some of the matter which was buried was rich in sulphuret- 
ted hydrogen. Two weeks later he examined the air in and 
around this pit, and repeated the trials at intervals for about 
five months. " Sulphuretted hydrogen was not detected, 
even in the air, fourteen inches from the ground ;" that is, 
four inches above the top of the deposit. " Ammonia was 
not found in any appreciable amount." Of what is called 
the " mephitic" gases there was none. He then examined 
the air one foot and a half from the base of the old Roxbury 
sewer, the bottom of which was not water-tight. " The ex- 
amination failed to detect sulphuretted hydrogen or marsh- 
gas." Oxygen, nitrogen, and carbonic acid were the only 
gases he found. In an appendix. Professor Nichols gives a 
resume oi Fleck's investigations, which proved that air directly 
over a dead body was contaminated with no other than car- 
bonic acid gas ; that in none of his examinations in earth 
purposely arranged to favor the formation of so-called me- 
phitic gases could more than mere traces of sulphuretted 
hydrogen and ammonia be obtained. The process of de- 
composition was one of oxidation, forming carbonic acid. 

The population of the town of Kendall was fourteen 
thousand in 1878. One million gallons daily * of sewage 

* Massachusetts Board of Health Report, 1879. 



Soil just below 


Surface of sewage farm. 


the sewage. 


Soil 


six inches below. 


0.0043 




0.0039 


0.0076 




O.OII5 


0.1983 




0.07 IS 


0.2046 




0.0785 


5.56 




5-50 


0.0268 




0.0214 



148 VAGARIES OF SANITARY SCIENCE. 

from this town are poured on five and a half acres of land 
for three hundred and thirty-five days in each year. This 
process has been going on for five years ; the effluent water 
is entirely clear. The soil from this farm, taken six inches 
below the surface, has been shown by the repeated exper- 
iments of Dr. A. Dupre to be purer than soil taken from 
unsewaged surface of the earth. 



Soil of unsewaged 
surface. 

Ammonia 0.0026 

Nitric acid 0.0077 

Organic nitrogen . . . 0.1178 

Total nitrogen . . . . 0.12 18 

Organic matter .... 6.8 1 

Phosphoric acid .... 0.0214 



The few pages that make the reports of these scientific 
men nullify the tons of imagery and verbiage about our 
contaminated soil that the sanitarians have put forth for 
nearly forty years. Yet they have continued to keep the 
public mind in a panic, as if these examinations had never 
been made. 

Confounded by their own reports, which were full of evi- 
dence proving that a soil which received organic matter was 
incapable of producing disease through the agency of foul 
gases, the sanitarians again accused the germ ; this, they 
said, sought the filthy soil and there multiplied. They made 
no investigations, no experiments, but they detailed with 
painful accuracy the way in which the germ propagated 
itself in the foul soil and was transported from thence to 
our bodies. They described the mode of generation, — the 
birth, life, and death of those disease-germs which had never 
yet been discovered, but only guessed at. 

The same ridiculous result awaited them here as with 
their distracted ravings about the germ in the air and the 



THE SOIL. 149 

water. M. Miquel * proved by repeated experiments that 
air which passes through the earth not only carries with it 
no germ, but is completely purified by the passage. He 
says, "Ainsi done I'air qui filtre a travers le sol non 
seulement n'enleve pas avec lui les microbes-bacteries 
qu'on y rencontre to uj ours en quantites innomb rabies, mais 
encore se purifie completement." He then, as he says, " ex- 
aggerated" his experiments by mixing earth with putrid 
meat and directing currents of air through the mixture; 
these currents of air were proved to be free from germs : 
"qui se montrerent aussi vierges de germes que I'air 
soigneusement filtre a travers une longue bourre de coton 
sterilise." 

Before these facts, he says, it is impossible to believe for 
a moment that air which passes through the soil is capable 
of raising a single germ. 

Fliigge t says that in unsterrlized earth pathogenic bacteria 
are destroyed by the ordinary putrefactive bacteria, and the 
acidity of such earth prevents the reproduction of patho- 
genic germs. That when organic matter is poured on the 
ground it is not fixed ; it is decomposed, and the organic 
molecules are oxidized; organic substances are made in- 
organic {vollstandig miner alisiri). This is brought about 
not only by chemical action, but by the putrid bacteria in 
the superficial layers. Sterilize the earth, he says, and this 
is not so complete. Natural ground always has micro-or- 
ganisms to aid the chemical activity. Micro-organisms in 
the ground-air are seldom found. {Micro-organismen wer- 
den in der Bodenluft ausnahmlos vermisst) He is no less 
positive that air containing them is not drawn into the 
houses. {Auch in die Wohnhduser werden mit der Bodenhift 
niemals Bakterien eingefuhrt) 



* Les Organismes Vivants, 1883. 
■f- Grundriss von Hygiene, 1889. 



150 VAGARIES 0I< SANITARY SCIENCE. 

And again, — 

Fliigge * says the uniform result has been obtained that 
even strong currents of air are unable to carry a single bac- 
terial germ through a layer of earth a few centimetres in 
thickness. He adds, " From our present knowledge it is 
improbable that pathogenic bacteria multiply in the soil. 
Hence, it appears to be of relatively little importance for the 
question of pathogenic bacteria in the soil whether the latter 
is more or less contaminated, — that is to say, impregnated 
with excreta." Lehman,t Professor of Hygiene in the Uni- 
versity of Wiirzburg, is no less explicit in his declarations 
respecting the ground-air. He says it contains no micro- 
organisms. (" Die Grundluft ist pilzfrei.") 

In Annales d' Hygiene % is recorded the story of an investi- 
gation made by a committee of fifteen hygienists, to inquire 
if the spread of sewage at Gennevilliers was prejudicial to 
the public health. The report is made by M. Ogier. Ex- 
periments made with the typhoid bacilli proved that these 
retain their vitality in passing through sterilized earth three 
feet deep, while they are destroyed in transit through nat- 
ural or unsterilized ground at a depth of from eight to six- 
teen inches. The committee concludes that the spread of 
the sewage of Paris, even with the system of " tout a Vegoutl' 
over the soil of Gennevilliers did not imperil the public 
health. 

Dr. Cornil § reports the visit of a French commission to 
the sewage-farms about Berlin. On their arrival, Professors 
Koch and Virchow met and accompanied them on the tour 
of inspection. Professor Koch showed the commission that 
the farms took the fecal matter of one million five hundred 
thousand people ; that there was no danger of progressive 
saturation of the soil ; that the water of the drains had been 



* Micro-Organisms, 1890. f Methoden der Hygiene, 1890. 

X 1889. \ Revue d'Hygidne, 1888. 



THE SOIL. 151 

drunk for years (" tout le monde la boit et la trouve bonne') ; 
and that they had begun to estabHsh asylums there for con- 
valescents, Virchow told the commission that the earth 
there was a complete purifier; that ** the pathogenic mi- 
crobes are destroyed on the surface and in the superficial 
layers of the earth by their rivals, the putrefactive bacteria, 
which greatly outnumber them." 

At the Congres Internationale d' Hygiene, 1889, MM. 
Grancher and Richard reported on the " action du sol sur les 
germes pathogenesy They say that according to Hoffman 
it requires two or three years for a solution of marine salt 
to reach a depth in the earth of nine feet ; that the bacteria 
could not travel as fast as the solution ; that they are in the 
superficial layers ; on the surface they number one hundred 
and twenty thousand to the centimetre, while twenty inches 
below there is an abrupt fall to two thousand. They showed 
that the typhoid bacilli did not penetrate the earth deeper 
than fifteen to twenty inches. They declared it was now 
proved that air passing through the earth had not the power 
to take with it the least germ. En resume, they say, " Dis- 
ease-germs are found, if at all, only in the superficial layers 
of the earth ; they multiply there with difficulty ; are de- 
stroyed by putrid bacteria and by solar light; and the 
water-level six to nine feet below the surface is safe from 
them." 

At the same congress M. Wurtz showed by experiment 
that the typhoid bacillus penetrated the earth in loose soil 
not more than sixty centimetres, even where the wetting 
(arrosage) with the bacilli was kept up for ten days at a 
temperature of 72° F. In Revue d' Hygiene, 1889, are re- 
corded the experiments of MM. Grancher and Deschamps 
with the typhoid bacillus. They filled a tube eight feet long 
with earth and kept a continuous flow, for sixty days, of a 
fluid which held the typhoid bacilli. Not only was no trace 
of these found at the inferior end of the tube, but when 



152 VAGARIES OF SANITARY SCIENCE. 

this was tapped sixteen inches from its upper surface, not 
a typhoid bacillus appeared. 

As we have seen in previous chapters, it did not need 
these physical proofs to convince us of the harmlessness of 
a soil encumbered with organic matter. The histories and 
mortality-tables of numberless small localities, entire cities, 
and two vast empires, which the sanitarians have uncon- 
sciously collected in their health- reports, — those sarcophagi 
of Sanitary Science, — evinced that what they called soil-satu- 
ration, instead of being accompanied by an increase of zy- 
motic disease, was invariably attended with its diminution. 

Through these reports they have put themselves in a 
contemptible dilemma. Either alternative confers on them 
disgrace. Either there is no truth whatever in what they 
have laid down as the fundamental principles of Sanitary 
Science, or with no apparent purpose except the acquisition 
of power and pelf, they have been guilty of the despicable 
fraud of exciting panics in the public mind by representing 
falsely the condition of the air we breathe, the water we 
drink, and the soil on which we tread. 

Imagine the dismay of the enlightened man who has 
nourished a delicacy of sentiment regarding a pure air, a 
sweet water, and a clean soil, in the belief that thereby he 
promoted bodily health and longevity, and finds the illusion 
rudely swept away by the crushing evidence that the sani- 
tarians have garnered ! That henceforth material benefits 
are not to be looked for; that the sole reward for living 
cleanly is a sense of comfort, decency, and self-respect; 
and that, except this, as he meditates on the watchwords 
** pure air, pure water, pure soil," he must view them only 
as the exuviae of Sanitary Science. 



THE SEWER-GAS. 153 

CHAPTER VII. 
The Sewer-Gas. 

The cerebral fecundity that evolved Sanitary Science out 
of the triune problem of pure air, pure water, and pure 
soil was no less active and fertile in providing accessory 
creations to sustain and adorn the new science. 

That which transcended all others in importance was the 
invention of sewer-gas. This imaginary substance has 
afforded material for flights of sanitary fancy such as no 
element or combination of elements has permitted it to 
reach. We had got the air purified ; sentinels were posted 
at every avenue to prevent its reinfection ; the water had 
undergone thorough ebullition ; the sleepless eye of the 
sanitary inspector was fixed on the ice; the soil, over- 
charged with filth, had been purged of its impurities through 
the sewers, and our minds were at peace, when it was sud- 
denly discovered that the very thing we had been doing had 
augmented our dangers a thousand-fold. 

The sanitarians told us that although we had in a measure 
relieved the filthy soil, we had actually prepared something 
whereby the essence of that filth was concentrated in the 
sewers as a gas, and practically had so arranged things that 
this gas was " laid on" in our houses. The sewers were 
vast laboratories in which it was generated ; in the New 
York sewers alone* eight hundred million cubic inches of 
sewer-gas were emitted daily, and the larger the sewer f 
the greater the quantity of gas there was generated. 

One woe following another so quickly, we came near 
cursing the day that Sanitary Science was born. The 

* Medical Record^ vol xxxi. f London Lancet^ 1882. 



154 VAGARIES OF SANITARY SCIENCE. 

apocalyptic ardor which had pushed and firmly grounded 
the elementary principles of the new science received a 
fresh glow and a fiercer impulse. An extravagant fervor 
seized the amateurs of both sexes; they outdid the pro- 
fessionals in predictions of disaster from the new danger. 

The triple alliance, which the reformers had made with 
the ladies and the clergy, was now to be reinforced by a 
liaison with the plumber for offensive and defensive opera- 
tions against the sewer-gas. Elated with his new acces- 
sion to the dignity of being tolerated in the company of 
scientists, he became in a manner transfigured ; and as he 
lifted up his voice for sanitary reform he was no longer a 
plumber ; he was a " Sanitary Plumber ;" and he bore this 
device on his escutcheon in his future reprisals on the 
community. 

This guide, philosopher, and friend proceeded without 
delay to fabricate and set traps for us, which he said would 
shield us from the deadly vapor. He had no sooner put 
one in than it was shown that the gas was generated in 
such quantities in the sewer that it was forced past the trap. 
The next one he placed went through that inscrutable 
process of " siphoning out," and we were worse off than if we 
had had no traps at all. We must now ventilate them; 
when this was done, the joints began to leak, and he said 
the material of the pipes was so weak that it could not 
stand the peppermint test ; and in some way that future im- 
provisation alone would explain, it was proclaimed that 
sewer-gas escaping from a pin-hole would cause disease 
.much more surely than if it were passing out in volumes a 
foot in diameter. There was no safety but in tearing out 
all of the old fixtures and replacing them with new ones. 
After their renewal we were no better off, for not a day 
passed that the sanitary dervishes did not relate the poison- 
ing of whole families by sewer-gas. 

Just when, where, and by whom sewer-gas was invented 



THE SEWER-GAS. 155 

is shrouded in the mists of doubt and obscurity. Unlike 
other great contrivances, there seems to be no competition 
for the honor of having invented this. It was soon after 
1850 when the gases of sewers first began to be talked 
about; but it was not until about the year 1857 that it was 
decided, not by chemical experiment or by any other inves- 
tigation, but by a whim of the sanitarians, that there should 
be a distinct substance known as sewer-gas. 

The most discordant and contradictory properties were 
at once imputed to it. Sometimes its gravity caused it to 
descend into the bowels of the earth ; again, by its surpass- 
ing levity, it ascended to heaven. Its powers of lateral 
diffusion were illimitable : it would permeate masonry eight 
feet thick ; its backward pressure was enormous ; then, un- 
like other gases, instead of finding vent at the man-holes and 
large openings of the sewers, it had such affinity for the 
human system, to poison and destroy it, that it remained 
pent up until it could find egress through some crack or 
pin-hole and escape into our dwellings. Sometimes it had 
a vile odor ; again it had a faint mawkish smell ; but the 
climax of danger was reached when it was odorless. 
" Poisoning by sewer-gas * which has no smell is the cause 
of many maladies ; we destroy the warning odor without 
destroying the poison." " We take the rattle off the tail of 
the snake that he may the better bite us with impunity.'* 
"Better let the atmosphere of a house be nauseating from 
the fumes of x^c^ntfceces or pestilential from the fumes of a 
cesspool, than poison its inhabitants with the demon sewer- 
gas skilfully laid on by a system of closed drains." Ven- 
tilating them by gratings in the street " is Machiavelian in 
its refinement of folly and wickedness." 

It was a painfully well-known fact f that a whiff of sewer- 
gas produced a peculiarly marked effect ; it often happened 

* London Lancet, vol. i., 1882. f London Lancet, vol. ii., 1SS4. 



156 VAGARIES OF SANITARY SCIENCE. 

that the victim suffei^ed most who had been the least exposed to 
it. " It makes its way out probably in gusts." 

Dr. F. H. Hamilton * says that the united skill of the 
specialists has not succeeded in keeping our houses free 
from sewer-gas. " A generation has come and gone, thou- 
sands upon thousands have died, and looking at our deci- 
mated households we may well ask. How many more must 
be sacrificed to this terrible experiment ?" 

Its composition was almost as variously described as its 
properties. " Sewer-gas f is a comprehensive term used to 
designate a greater number of gases and vapors, very com- 
plex in composition. This complexity of composition is 
not due to the great number of elements represented in 
the gas, but to the variety of ways in which these elements 
may combine with each other. The elements present in 
sewer-gas, and indeed certain of their compounds, are prac- 
tically without any injurious effect. There are, however, 
products intermediate between these elementary bodies and 
the more ultimate products which are deleterious, and in the 
possibility of the formation of just these products lies the 
danger of sewer-gas." ** It is unfortunate { that we do not 
know the exact components of sewer-gas, and that there are 
no means of ascertaining how it acts upon the system." The 
risk from sewer-gas § is probably not so great as many sup- 
pose ; it is a slight risk, but " a slight risk of terrible danger." 

" Not much is known || of the noxious gases and vapors 
contained in sewers, or how they are generated," and " the 
quantity of gas in a sewer is of no consequence ; it is the 
degree of concentration which is important." " Sewer-gas \ 

* Popular Science Monthly, vol. xxii. 

\ Journal Franklin Institute, 1887. 

X Eighth Report of Massachusetts Board of Heahh. 

\ E. C. Clark, Massachusetts Board of Heakh Report, 1879. 

II Massachusetts Board of Health Report, 1880. 

\ Ziemssen, vol. xviii. 



THE SEWER- GAS. 157 

is a continually varying mixture of the gases which make 
up the atmosphere and a relatively small proportion of other 
gases." " Poisonous sewer-gas * cannot be clearly defined ; 
it is known chiefly by its effect ; even its odor is rarely a 
marked one." Dr. F. H. Hamilton f says that sewer-gas is 
a compound of air, vapor, and gases in constantly varying 
proportions. " Sewer-gas J is of a singularly light char- 
acter, and has a tendency to ascend or draw towards any 
heated part of the house. Also, it is so penetrating that I 
have known this gas to pass through floors and through 
chinks in two-foot walls. It will find out the smallest open- 
ing in any pipe." " The weight of sewer-gas § depends on 
circumstances, so that the specific gravity is always vary- 
ing." Sewer-gas is a product of fermentation, and is heated 
by this fermentation, and so is rendered lighter than when 
it is cold. Dr. Grifiin || quotes Professor Lindsley as saying, 
" Sewer-gas is so subtle that its presence is many times not 
detected, and yet so laden with the germs of disease that 
diphtheria, scarlet fever, typhoid fever, and other fatal mala- 
dies are the sure event to those who dwell in such air-poisoned 
houses." Sewer-gas \ " is something sui generis^ and is the 
distinct product of the modern system of sewage disposal ;" 
and in the same article we read, " Concerning the nature and 
properties of sewer-gas proper, the sanitarians and sanitary 
engineers are ignorant." 

Professor Kerr, in an address before the British Civil and 
Mechanical Engineers' Society,** said, " We know this gas 
has two qualities which are extremely obnoxious :" one of 

* Waring, Sanitary Drainage, etc. 

•}• Popular Science Monthly^ vol. xxii. 

% Seventh Massachusetts Board of HeaUh Report. 

I Builder, 1 88 1. 

II Chicago Medical and Surgical Examiner. 
^ London Lancet, vol. i., 1S82. 

** Popular Science Monthly, vol. xxii. 
14 



158 VAGARIES OF SANITARY SCIENCE. 

these qualities was that " it ascended to the highest level by 
reason of deficient specific gravity ; and the second quality 
was that when it reached the highest level it exercised a 
pressure, being an extremely elastic gas. When the sewer- 
gas had reached the highest level it exercised a powerfiilly- 
elastic pressure to force its way out, and succeeded in forcing 
its way. It got into the houses, and if there was no other, 
there was this grievance to complain of, — that this pestifer- 
ous and poisonous gas forced its way from the sewers into 
our houses, and of course reached the vital organs of those 
who occupied them." It would be difficult to devise a more 
perfect way to secure the entrance of sewer-gas into our 
houses * than the present system. We are practically laying 
on the gas of decomposition as we do illuminating gas. The 
closer and better the pipes, the worse we are off; with the 
perfect drains all the gas is retained and connected with the 
houses. " Sewer-gas is a special product of our refined and 
scientific system of sewage ; we have now a perfect appa- 
ratus for treasuring it up and laying it on into our houses." 

Surely, the reader will say, it is not possible that these 
men in the livery of science could put forth these statements 
without any experiment to support them. Such is the fact. 
Not an experiment, or an attempt at an experiment, to prove 
the truth of this incoherent balderdash had ever been made 
by these so-called scientists. Their work and that of 
Lemuel Gulliver rest on the same basis, — an exuberant 
imagination. 

If we were a little confused by the diseases that water 
caused, those that resulted from sewer-gas bewildered and 
confounded us. 

They were contradictory in their symptoms, and as va- 
rious in their nature as were the properties and composition 
of the gas. Ague,t all forms of malarial fever, typhoid, 

* London Lancet, 1882. f De Verona, Sewer Gas, 1880. 



THE SEWER- GAS. 1 59 

typhus, and spotted fevers, scarlatina, abscess, thrush, boils, 
headache, chicken-pox, cholera, diphtheria, dysentery, 
eczema, enteritis, diarrhoea, conjunctivitis, convulsions, croup, 
glanders, erysipelas, general debility, neuralgia, rheumatism, 
whooping-cough, broken breast, measles, rash, phthisis, 
plague, childbed fever, vertigo, apoplexy, yellow fever, 
small-pox, and perhaps myelitis of the anterior horns ! * It 
must be remembered that all of these diseases, except 
" myelitis of the anterior horns," had prevailed for gener- 
ations prior to the invention of sewer-gas. 

We see that pretty nearly every ill that afflicts the human 
race is caused by it, except alopecia, strabismus, and in- 
growing toe-nail. 

We have said that no experiments had been made with 
sewer- gas. 

In a great many — almost all — of the treatises published 
on that subject by the sanitarians, professional or dilettanti, 
Dr. Barker's experiments with sewer-gas are cited. Dr. 
Barker confined animals in a chamber and subjected them 
to breathing the air of a cesspool. Either the sanitarians 
who so profusely quote him never read the account of his 
experiments, or they do not consider the opening sentences 
which precede their detail of any importance. In the Sani- 
tary Review, vol. iv., 1858-59, Dr. Barker says, "For the 
purpose of experiment I selected a large cesspool which 
received, together with the animal excreta, the liquid refuse 
of an inhabited house. The cesspool was full, and had at 
all times so bad a smell that during the hot weather the 
vicinity was scarcely tolerable. The inhabitants of the house, 
however, had not for many years suffered from any epidemic, 
nor did the near presence of the cesspool seem to affect their 
general health. This fact is but fair to state in connection 
with what follows." 

* Medical Record, 1887. 



l6o VAGARIES OF SANITARY SCIENCE. 

Yet these experiments are constantly exhibited by the 
writers on sewer-gas to illustrate its poisonous effect on 
the human system under ordinary circumstances, when Dr. 
Barker expressly declares that it had no effect on the family 
which had been subject to it for many years. In a small 
chamber — capacity five thousand eight hundred and thirty- 
two inches — made of wood and glass, he introduced dogs, 
and exposed them from five to twelve hours to the cesspool 
air drawn into the box. The dogs had diarrhoea and vom- 
iting, but soon recovered. He let a mouse into the cesspool 
to within three inches of its contents and kept it there four 
days. The animal was well and lively on removal, but the 
next day died. He kept one dog in the chamber for two 
days, giving him fresh air only when the chamber was 
rapidly cleansed. The dog was thin and weak for six weeks 
after, but recovered. By pouring sulphuretted hydrogen 
into this box he destroyed the life of some animals ; but 
these experiments amount to nothing at all as tests of the 
pernicious effects of sewer-air on the human body. 

In 1822, Parent du Chatelet* says that he visited every 
sewer in Paris; was present at all kinds of work that the 
employes were engaged in ; questioned them separately and 
en masse; visited them at their houses to ascertain the 
diseases they were subject to ; tried to get from them con- 
tradictory statements to compare them, and to invent new 
questions to correct errors. The sewers of Paris were then 
without means of ventilation, so that sometimes men who 
took no precaution on entering them were asphyxiated, as 
men often are on descending into wells and beer-vats. The 
record showed that between 1783 and 1823 thirty men had 
been asphyxiated in these sewers, and that many of them 
died. The diseases of the sewer-men were few in number 
and not of a grave character. Ophthalmia and rheumatism 

* Hygidne publique. 



THE SEWER- GAS. l6l 

were the only ones that prevailed among these workmen 
more than with other people. Ulcers, wounds, and cuta- 
neous eruptions were not only not aggravated, but the 
workmen considered sewer-water an efficacious remedy for 
them. He found no exception, even when the sewers had 
been long neglected. The only disease that he thought was 
aggravated by this work was syphilis. In winter the tem- 
perature in the sewers was so soft that it favored the growth 
on their walls of fungi-like mushrooms ; these were gathered 
with care by the workmen and eaten ; they made " un des 
meilleurs plats de leur modest repast He says that in no way 
was the health and longevity of these workmen impaired. 
{^^ Leur sante peut etre consideree parfaite et fort rarement 
derangee.'') Parent says he had often heard that this occu- 
pation was the cause of putrid fevers. He declares he had 
never seen one of these workmen who had such fever, and 
that "la veritable observation'' had destroyed all of his pre- 
vious opinions and prejudices. 

If this sewage is so innocent when new, is it made noxious 
by time ? Observation alone, he says, could solve this ques- 
tion, and a unique occasion presented itself in the Amelot 
sewer, which had been stopped for years. It was a terror to 
workmen ; the authorities decided to clear it, if it could be 
done with safety. Parent du Chatelet was one of the com- 
missioners to superintend the work. Thirty-two men were 
selected, sixteen of whom had never worked in sewers. 
Their ages varied from twenty to seventy years. It required 
six months to complete the work ; two thousand loads of 
solid and six thousand loads of semi-solid sewage were 
removed. When the work was done, the men were assem- 
bled and one after another examined. They displayed the 
best of health, — ''la sante la plus florissantey Some of the 
more delicate ones had gained in ernbo7ipoint and vigor. 
During the work the air in the sewer was often examined ; 
at no time was the oxygen above 19; it was generally 18; 
/ 14* 



1 62 VAGARIES OF SANITARY SCIENCE. 

once it was below 14. The nitrogen was from 80 to 82, and 
sometimes the carbonic acid was above 2. 

In 1 87 1 the Metropolitan Board of Works in London 
ordered an investigation to ascertain to what extent sewer- 
men were subject to typhoid fever. The report was made 
by J. W. Bazalgette, C.E., on January 18, 1872. Five in- 
spectors had been employed from twenty-three to forty-nine 
years ; none of these had ever had fever. One hundred and 
sixteen men had been employed in cleaning sewers ; their 
ages varied from nineteen to sixty-eight years. They had 
been employed from one month to thirty-four years. None 
had had typhoid fever. Many years before, four of these 
had suffered from typhus fever. Forty-two had been em- 
ployed from one to fifty years as flap-keepers ; their ages 
varied from twenty-five to seventy-five years. One of these 
had had typhoid fever. Twenty-three had been at the 
pumping-station ; their ages varied from twenty-one to fifty 
years, and they had been employed from one to twenty-one 
years. None had had fever. At another pumping-station 
was a group of seventy-eight men, whose ages varied from 
nineteen to seventy-eight years, with a length of service of 
from one to nine years. Among these there had been one 
case of typhoid fever and eight cases of intermittent fever. 
Fourteen men were employed in cleaning ventilators ; their 
ages varied from twenty-two to sixty-eight years, and their 
length of service from one to twenty-three years. No fever 
had occurred in this group. Ten were employed as chain- 
men ; their ages varied from forty-two to sixty-nine years, 
and their length of service from four to twenty-six years; 
in this group there had been no fever. 

Here is an astonishing report, an official one ; it contains 
sixteen pages. Of two hundred and eighty-seven men, a 
large number just in the typhoid age, only two had ever had 
typhoid fever. This document does not say if these men 
were or were not subject to any other class of diseases. 



THE SEWER-GAS. 1 63 

The surveyor of Chelsea,* in his report to the vestry, 
says that, contrary to the dicta of many sanitarians, the 
sewermen there show vigorous health and vitality, though 
they spend seven hours a day in the sewers, in cramped 
positions, dealing with offensive and dangerous matter. One 
who is now pensioned off is eighty-six years old, and was a 
sewerman for twenty-eight years. Another has been at 
work over thirty years in the sewer ; another is seventy-five 
years old, and has been at work thirty-eight years ; another, 
fifty-five years old, has been at work in the sewer for thirty- 
six years, and all the other sewermen enjoy equally good 
health. 

In 1878 Professor Bartholow read a paper before the 
American Social Science Association at Cincinnati. After 
speaking of the complications of sewers and sewer-gas with 
politics, he said, "We now know that no amount oi fecal 
accumulation can cause typhoid, unless, indeed, its germ be 
present;" that specific diseases were caused by specific 
germs; that the germs cannot rise from a moist surface; 
that they must be dried and carried by the wind,— a process 
which could hardly take place in a sewer. He was followed 
by Colonel Anderson, the city engineer, who said that if 
sewers were properly constructed and ventilated, no sewer- 
gas could form to endanger health. Assistant Engineer 
Hobbie said that he spent many hours a day in the sewers ; 
that the air in them was superior to much of the air in the 
streets and alleys of Cincinnati ; that he and his men were 
exceptionally free from disease. 

In the Medical Record, vol. xxii., 1882, Dr. Burral writes 
that during 1879 ^^^ 1880 there died in New York sixty- 
four plumbers ; none of these died of zymotic disease, except 
one of cholera morbus. Yet here is a large body of men 
exposed to sewer-gas in that most dangerous of all condi- 

^ Building News, October i, 1886. 



164 VAGARIES OF SANITARY SCIENCE. 

tions, issuing from a pin-hole, — as well as where it escapes 
in huge volumes, — who are found to be specially exempt 
from just those diseases that sewer-gas is said to cause. 

During the last three years, as occasion has presented 
itself, the author has inquired, in different cities, of engineers, 
superintendents of sewers, workmen in the sewers, and of 
plumbers, to ascertain the effect of sewer-air on the health 
of those exposed to it. He has asked if sewer-air in any 
way damaged their health, or if, after long exposure to it, 
whereby their clothing became saturated with it and befouled 
by sewer-contents, they took any precaution against expos- 
ing their families ; or if they ever mistrusted that their fami- 
lies were in danger ; or if they ever demanded or received 
extra pay on account of exposure to sewer-air ; or if blood- 
poisoning ever followed the reception of a wound ; or if they 
objected at any time to enter sewers lest disease should be 
contracted. Some to whom these questions have been put 
have smiled contemptuously ; some have laughed outright ; 
others have listened to them soberly ; all, without exception, 
have answered ** No" to each of the questions. Many of 
these men had been employed in the sewers for twenty 
years. Some of the superintendents declared that they had 
had two, three, four, and five hundred men under their 
observation, and one gave the number as over a thousand 
who had been subject to his orders. 

In 1882 and 1883 there was a severe epidemic of typhoid 
fever in Paris.* Of eight hundred and fifty men employed 
in the sewers, seven had typhoid fever in 1883, twelve had 
typhoid fever in 1884, and in 1885 two more had the same 
disease. 

This is the only instance which the author can find of 
sewermen having ever been affected by zymotic disease of 
any kind. Every year thousands of visitors make the tour 

*Annales d' Hygiene. 



THE SEWER-GAS. 165 

of the Paris sewers. It requires nearly half a day to make 
the circuit. None of those who take this excursion — all are 
unaccustomed to sewers — ever use any precaution on enter- 
ing them or any antidote on emerging from them. 

In the Connecticut Board of Health Report for 1885-86 
are accounts of inspections of the county jails in Connecticut. 
At the New London jail, one of the conspicuous defects was 
the imperfect plumbing, the sole intent of the plumber being 
to insure the passage of the sewage by gravity, without any 
attempt " to prevent the return of the sewer or cesspool gases 
into the building." At one point a free opening existed, 
through which exhalations passed directly into the kitchen. 
There were two large leeching cesspools on the premises ; 
one was only fifteen feet from the jail ; on the other side, a 
little farther off, was another which received excreta from 
the prisoners' pails. No sickness is reported here. 

At Bridgeport jail there are no receptacles for the prisoners* 
pails, and no arrangements to carry off the effluvia ; the water- 
closets are insufficiently flushed. From two points the flow 
of sewer-gases into the kitchens and corridors is unrestrained, 
which " must necessarily pollute" kitchens and corridors. 
This jail was then fifteen years old. " The officers of the 
jail stated, upon inquiry for the hospital accommodations, 
that there was no use for a hospital, it was so seldom that 
any one was sick." The warden of this jail, in an interview 
with the author, declared there had not been a case of zymotic 
disease there for fifteen years, and but one death, and that 
was caused by injury ; a man with delirium tremens had 
dashed his head against the wall of his cell, and died of in- 
flammation of the brain. 

Litchfield's jail was in the same condition respecting ven- 
tilation and sewer-gases, and the disposal of the excreta of 
the prisoners. " The health * of the prisoners was good. 

* Connecticut Board of Health Report, 1885. 



1 66 VAGARIES OF SANITARY SCIENCE. 

It was said to be quite rarely that any sickness occurred 
among them." At Danbury * matters were still worse ; 
sewage from the prison part is received in a cesspool only 
eight feet distant, which was full and overflowing on the sur- 
face, and fifty or seventy-five feet farther the excreta of the 
prisoners settled on a little surface of swampy ground. Other 
cesspools were near the building, one only ten feet from the 
entrance to the jailer's office. In reply to an inquiry by the 
author, the warden of this jail said that since its foundation, 
twelve years before, there had been no sickness among the 
prisoners except such as they brought in, and they speedily 
recovered after admission. The Tolland County jail was 
"by far the dirtiest jail" the inspector had ever visited. 
Here " there were no traps to sinks or urinals, and no pro- 
tection against the admission of sewer-gas through them." 
The inspector — the secretary of the Connecticut Board — 
regrets that there is occasion to speak so plainly, but the law 
makes it his duty. The sheriff assured the author by letter 
that he never knew or heard of any sickness occurring in 
Tolland County jail, except such as the prisoners brought in. 

During the last twenty years there have not been less than 
fifty thousand, — probably one hundred thousand,— people of 
both sexes and all ages above that of childhood admitted to 
the different county jails in Connecticut, who were sentenced 
for a period varying from two or three days to eighteen 
months ; and — incredible circumstance ! — there is no record 
that there was ever, — not an epidemic, but a single case of 
zymotic disease occurring in any of these prisons. In some 
of these towns numerous epidemics of diseases of this class 
have prevailed, sometimes close to the prisons ; but for some 
reason the prisons escaped the visitation. 

The New Jersey Board of Health, 1880, reports on the 
condition of the jail at Warner. It has no drainage except 

* Connecticut Board of Health Report, 1886. 



THE SEWER- GAS, 1 6/ 

into a cesspool, which has no ventilation for the sewer-gas, 
and a great deal passes into the soil ; there is also no ven- 
tilation for the cells. No sickness is reported as occurring 
in this jail. The sewerage at Morris County jail is by cess- 
pools ; in spite of the traps, foul gases are forced back into 
the building. " The health of the jail is reported excellent." 
At the Barry County jail,* Michigan, " there is not the 
slightest attempt at ventilation, and when the air comes up 
from the dark and unventilated basement, laden with the 
fumes of vaporized tobacco-quids and the expectoration of 
diseased lungs, and mingles with the gases arising from the 
privy, the stench must be intolerable." No sickness is re- 
ported at Barry County jail. At Washtenaw jail a foul odor 
was noticed as soon as the door was opened. The report 
declares that a more ingenious arrangement for producing 
unsanitary conditions of the worst sort could hardly be 
devised than the water-closet arrangements. Sewer emana- 
tions are pouring into the building ; " the only provision 
for air-supply was through the sewer-pipe by way of the 
filthy vault into the corridors." " A strong current of air 
was constantly ascending into the women's quarters, being 
drawn through the privy-seats of the men's closet through 
the vault, thus furnishing the female prisoners a doubly-con- 
taminated air as their fresh-air supply." Rheumatism, bron- 
chitis, — diseases of the urino-genital organs, are reported here. 
Typhoid fever and diphtheria are not mentioned. At Jack- 
son County jail is the same shameful uncleanliness, but no 
sickness is reported. At the House of Correction in Ionia,t 
the sewerage, plumbing, and ventilation are in the worst 
possible condition ; the arrangement here is " an admirable 
one for the equal distribution of poisonous gases through 
all the cells." No sickness is reported. At the Montcalm 



* Twelfth Michigan Board of Health Report. 
\ Thirteenth Michigan Board of Health Report. 



l68 VAGARIES OF SANITARY SCIENCE. 

County jail * the defective condition of the sewer was such 
that offensive gases were constantly given off, making " the 
stench absolutely intolerable." The foul odors were driven 
into the female corridors and vice versa. Here was a case 
of diphtheria, and report says that the arrangements were 
such that a more ingenious device for spreading contagion 
could not be contrived. The cesspool is so arranged that it 
is " the best calculated to secure a wholesale poisoning with 
sewer-gas that could possibly be devised." Here seemed a 
test case ; the disease and all of the conditions for its spread. 
As no further account was given of this diphtheria, the author 
wrote to the sheriff of Montcalm County jail for information. 
He replied that one young man died from this disease, but 
that it did not spread, and had not been here at any time 
previous to 1886. 

We have seen what little effect sewer-gas had on the inr 
habitants of Newport. 

The seventh report of the New Hampshire Board of 
Health records an inspection of Rockingham almshouse. 
The building is old and filthy ; the water-closets are in an 
intolerable condition ; the several sinks are all untrapped, 
and " there is nothing to prevent the building from being 
constantly filled with sewer-gas and other odors from cess- 
pools. In fact, so far as is known, the entire sewer system 
of the institution does not possess a trap." This building 
had been complained of five years before as being in the 
state here represented. On the day of inspection there were 
one hundred and ninety-two inmates. Not a single case of 
disease is reported, nor is there any hint that there had ever 
been any disease in this institution. 

The health of towns report for Massachusetts f says : " An 
inspection at Springfield disclosed that of two thousand nine 



* Fourteenth Michigan Board of Health Report. 

•j- Eighteenth Report, Massachusetts Board of Health. 



THE SEWER-GAS. 1 69 

hundred and thirty water-closets in use, more than one-half 
were not properly trapped or ventilated ;" *' of five thousand 
sinks, eight hundred and thirty-two discharged into cess- 
pools and three hundred and thirty-three on the surface of 
the ground ;" " of three thousand six hundred and thirty 
privies, a majority were in bad condition." That year the 
general death-rate of Springfield was 18.51 per thousand. 
Cases of zymotic disease were reported as follows : Scar- 
latina, twenty-six ; diphtheria, twenty-five. No typhoid fever 
is mentioned. 

As we have seen, the city of New Haven in 1885 * was 
reported to have five thousand untrapped sinks, out of which 
sewer-gas was pouring. This would imply that not less than 
about twenty thousand people of that city were continually 
exposed to this gas ; but, instead of having a large proportion 
of zymotic diseases, this class in that city had never been 
large, and, besides, had been steadily diminishing for ten 
years. Those cities, on the other hand, Hke New York, 
Brooklyn, and Boston, where the plumbing is under the most 
rigid supervision, and sewer-gas excluded, show the largest 
amount of zymotic disease ! 

From the first the influence of sewer-air in producing 
disease was contemptuously rejected by the Germans. Dr. 
Soyka f says the sewer-gas theory of disease is now taking 
the place of the worn-out (abgenutzeti) theory of drinking- 
water. Dr. Soyka shows by tables that in Hamburg, 
Dantzic, Frankfort, and Munich, as sewers and sewer-gas 
have been introduced into those cities, typhoid fever has 
been steadily on the decline ; and that this disease is most 
plentiful in the portions of those cities where there is the 
least sewer-gas, and vice versa ; and he declares that there 
is no proof whatever of any connection between this and 

* New Haven Board of Health Report, 
t Viert. filr Oefft. Gesiind., vol. xiv., 1882. 
H 15 



170 



VAGARIES OF SANITARY SCIENCE. 



the extension of epidemic disease. Professor Rohe * says 
that some physicians and sanitarians believe that sewer-air 
is the direct cause of typhoid and scarlet fevers, diphtheria, 
etc., while others believe that it is the breeding-place of in- 
fectious germs. ** There is no absolutely trustworthy evi- 
dence in favor of either of these doctrines." 

Every experiment to ascertain the chemical constituents 
of the air in modern sewers has proved that it does not 
differ materially from the atmosphere outside. In 1879 
Professor W. R. Nichols examined the air in the sewers of 
Boston. His report comprises twenty pages. He pur- 
posely chose the Berkeley Street sewer, which " is an ex- 
ample of the worst type of construction." He says, *' It 
was only extremely seldom that sulphuretted hydrogen 
could be detected, by employing for the purpose even a 
considerable amount of the sewer-air." While it may exist 
" in this sewer, I have never found enough to determine 
and to express it in figures." He gives the following ex- 
amples of examinations of sewer-air previous to his own : 



Year. 


Name. 


Place. 


Oxy. 


Nitr. 


Garb. 
Acid. 


Sulph. 
Hyd. 


Marsh 
Gas. 


Ammon. 


1829 . 

1829. 

1B58. 
1867. 

1870 . 

1871 . 


Gautier de Claubry . 

Dr. Letheby . . . ! 
Dr. Miller 

Dr. Russell '.'.'.'.', 
Dr, Nicholson . . . 

Berkeley Street Sewer 


1 

Paris. 

London. 
Boston, 


13-79 

17-4 

19-51 

20.71 

20 79 

20.79 

18.44 

19-33 

20.48 


81.21 

79.96 

78.81 

8i*.io 
80.35 


2.01 
3-4 
0.53 

O.II 

0.13 
0.40 
0.55 
0.23 
highest. 
0.40 


81 
trace. 


trace. 


trace, 
trace. 



He found the oxygen in this sewer as high as 20.90, nor- 
mal air being 20.96 ; and the carbonic acid was as low as 
.05. A glance at this table shows the immense advantage 
which the modern sewer has over those built before 1830, 



Hygiene 



THE SEWER-GAS. I/I 

in respect to the amounts of oxygen and carbonic acid 
which they contain. Neither Professor Nichols nor any 
previous observer found any of the " mephitic gases" which 
the sanitarians say abound in the sewers. Professor Nichols 
modestly suggests a query, " whether sometimes the sewer 
(or the water) is not made to bear the burden of charges 
for which there is no sufficient proof" He says that if a 
decomposing mass is so situated as only partly to fill a re- 
ceptacle which contains in addition a limited amount of 
air and to which fresh air does not have access, a very 
large proportion of the oxygen of the confined air dis- 
appears, and the space above becomes filled with the gases 
which have been produced, as a result of decay, in addition 
to what nitrogen of the air remains. " But," he adds, " no 
one of these substances is of a character to account for the 
filth-diseases which are believed to be caused or favored by 
breathing the emanations from drains or sewers, nor indeed 
do we know of any gaseous substance which is capable of 
producing these effects." " Sewer-gas is sometimes alluded 
to as a homogeneous mixture of light specific gravity, with 
immense diffusive power, acting as a distinct body, with its 
own individual characteristics, and referred to as soluble in 
water to such a degree, etc. ; this idea is utterly erroneous." 
In the Proceedings of the Royal Society, London, 1887, 
are recorded the experiments of Professor J. S. Haldane 
and Thomas Carnally, who were appointed to ascertain the 
condition of the sewers under the Parliament Houses, and 
the cause of the bad odors that were said to proceed there- 
from. After giving a brief resume of the analyses of sewer- 
air which had been made previously by various observers, 
they say that the air in the sewers examined was much 
better than might have been expected; that the carbonic 
acid was about twice, and the organic matter about three 
times, what it was in outside air; whereas the number of 
micro-organisms was less. They assert that the air was 



172 VAGARIES OF SANITARY SCIENCE. 

much better than that of naturally ventilated schools, and, 
with the exception of the amount of organic matter, it had 
likewise the advantage of mechanically ventilated schools ; 
that the sewer-air contained a smaller amount of micro- 
organisms than any class of houses ; that the carbonic acid 
in the sewer-air was rather greater than in houses of four 
rooms and upward, but less than in two- or one-roomed 
houses. As regards organic matter, the sewer-air was only 
slightly better than the air of one-roomed houses and much 
worse than that of other classes of houses. The carbonic 
acid may be due to diffusion from neighboring soil, but 
probably to the oxidation of organic matter in the sewers. 
The average number of micro-organisms was always less in 
the sewer-air than in outside air. The state of filthiness in 
a sewer had no effect on the number of micro-organisms. 
They say, " In view of the fact that sewer-air is to all 
appearances comparatively innocent as regards its micro- 
organisms, experiments were also made to see whether it 
contained any poisonous volatile base of the nature of a 
ptomaine. These experiments, so far as they went, had 
negative results." Experiments by the same observers on 
other sewers led to the same conclusions. The Bristol 
sewers * are completely shut off from outside air ; the num- 
ber of micro-organisms here was exceptionally small ; the 
amount of carbonic acid was less than was found in many 
schools. So far as micro-organisms are concerned, sewer- 
air " is twice as pure as outside air, — in summer, at any 
rate." They sayf that the connection of sewer-air and 
typhoid fever rests not on satisfactory evidence, but largely 
on a priori reasoning ; and " in the present state of our 
knowledge we should cease to attribute blindly to sewage 
emanations cases of disease of which we do not know the 



* Sanitary Record, 1887. 
f Cke?nical NewSf 1887. 



THE SEWER- GAS. 173 

cause, and patiently seek for convincing evidence as to the 
real cause." 

Mr. Haldane says * that the result of their researches will 
" tend to mitigate some of the terror with which we have 
come to regard sewer-air." That while it has " been sup- 
posed to be loaded with micro-organisms, it turns out to be 
some of the freest air from micro-organisms that can be 
found." *' What is," he asks, " the supposed evidence for 
the causation of typhoid fever and other diseases by the 
inhalation of sewer-air? We may dismiss as absolutely 
worthless collections of cases in which something has been 
found wrong with the drains in a house where typhoid fever 
has occurred." 

Dr. Eben Duncan,t in summing up the evidence in regard 
to sewer-air, says, " The air of a sewer, when it is properly 
ventilated, is much better from a chemical point of view 
than the air of crowded houses and schools, or even the air 
of houses in which one-half of the population of Glasgow 
lives. To many of these people it would be of great advan- 
tage to be permitted to live in an average sewer atmosphere 
rather than in the air of their own houses." As for the 
germs in sewers. Dr. Duncan says, " The number in sewer- 
air is actually less than the number in the outside air." The 
conclusion of the whole matter, therefore, is that it is scarcely 
possible that the germs of such diseases as typhoid fever, 
diphtheria, or phthisis can be carried back into our houses 
through moist drains and soil-pipes. 

Dr. Carmichael % reports a series of experiments to ascer- 
tain the pressure of air in sewers, of which so much had 
been said by the sanitarians to terrify the people. Some of 
his experiments were made with a water-closet which had 

* Sanitary Record^ 1 887, 

f Sanitary Journal, Glasgow, 189 1. 

X Ibid., 1880. 

IS* 



174 VAGARIES OF SANITARY SCIENCE. 

been used many years. Its soil-pipe was very foul. Into 
the same soil-pipe, which passed untrapped into the drain, 
three water-closets above were discharged. The mouth of 
the sewer, three hundred yards away, was submerged at 
high tide. He examined the air which came through two 
water-closets in twenty-four hours. In the worst possible 
condition, when the outlet was closed by the tide-water, and 
the roof-ventilator was closed also, only thirty-two grains 
of carbonic acid and -^^ of a grain of sulphuretted hydro- 
gen passed in twenty-four hours, and the amount of am- 
monia varied from -^ to -^ of a grain. " These are the 
quantities of the only sewage-gases existing in the soil-pipe, in 
estimable quantities, which pass through an ordinary water- 
closet hi twenty -four hours!' These quantities, he says, are 
perfectly harmless. " Thirty-two grains, the largest quan- 
tity of carbonic acid that passed, is less than the quantity 
of the same gas given off when a bottle of lemonade is 
opened. A man exhales in the same period four hundred 
times the amount which passes through the trap from an 
unventilated soil-pipe." 

The specimens of germs which he collected, "though 
kept from two to five months at cultivation temperature, 
have remained perfectly clean ; and, even though examined 
with a lens multiplying nine hundred diameters, exhibited 
no trace of life." He adds, " These experiments seem to 
me crucial, and to warrant the conclusion that germs do not 
pass through a sound water-trap." But he asks, " Do the 
fetid organic vapors of which we hear so much indefinite 
horror expressed, but of which so little is known, come 
through in appreciable amount?" He admits that there 
may be traces of these vapors ; but they are organic. If 
they pass through the trap they are included in the am- 
monia, very much less than yftt ^^ ^ grain in twenty- 
four hours. "This, I need scarcely say, must be harm- 
less." 



THE SEWER-GAS. 175 

Experiments made by Parkes and Burdon-Sanderson * 
have shown that the tension of air in sewers is seldom very 
different from that of the atmosphere ; or, if there be any 
difference, equiHbrium is quickly restored. Of twenty-three 
observations made on four different days by these observers, 
the tension was less in the sewers than in air outside, in 
eight it was the reverse, but on the average there was a 
slight indraught. 

In the Builder, vol. Ivii., are recorded the experiments of 
Mr, Santo Cramp, C.E., who studied the pressure of air in 
sewers ; very frequently the movement of the air was so 
feeble that the anemometer would not work. His exper- 
iments showed that where the action of air in sewers was 
strong enough to affect this instrument, down-hill currents 
were recorded two hundred and seventy-three times, as 
against up-hill currents on ninety-seven days. 

In 1 88 1 Dr. Rosahegyi,t after repeated trials with an 
anemometer, the fumes of ammonia, the fumes of cigars 
saturated with tincture of benzoin and with sulphuretted 
hydrogen, found that the movement of air in the Munich 
sewers is at all times very feeble, often none at all ; that 
when it does occur, it is generally downward towards the 
mouth of the sewers, and that, too, independent of the wind 
blowing into them ; that it follows the fall of the sewers and 
the downward flow of the water; that the air-current is 
strongest in the lower part of the sewers ; that it happens 
only very seldom that there is a reversal of the current of 
air, and then it is only temporary and for short distances, 
and is dependent on accidental circumstances. 

Professor C. D. Chandler,^ in a lecture on the atmosphere, 
said, *' The common idea that gas in our sewers exerts a 



* Report on Sanitary Condition of Liverpool. 

•f Zeit. fur Biolog, 

% Sanitary Engineer, February i6, 1882. 



176 VAGARIES OF SANITARY SCIENCE. 

pressure to get out is a great fallacy." He had yet to find 
a case to prove it. Some time before he had a lot of press- 
ure-gauges made, which he distributed among his students, 
telling them to apply them wherever they could, but there 
has yet been no case of pressure reported. He had a vent 
taken from the street-sewer to his laboratory, thinking he 
could get sewer-gas in plenty whenever he wanted it by 
simply turning the stopcock, but no pressure has yet been 
indicated. 

Again, March 2, 1882,* Professor Chandler said that 
sewer-gas itself was not dangerous, but the danger was from 
the bacteria for which it was the vehicle. The professor 
cites no experiments to prove that sewer-gas is " the vehi- 
cle" of disease-germs. May it not be that the reiteration 
of the charge by the sanitarians, that disease-germs are 
propagated in sewer-aIr, had imposed such a belief on him 
as it had on the medical profession at large and on the 
community ? 

In the Medical Record •\ Dr. H. W. Mitchell says that the 
effects of sewer-air have been greatly over-estimated ; that 
experiments recently made by the Board of Health of New 
York City in connection with the authorities of Columbia 
College have shown that the pressure of air in the sewers 
is inconsiderable, even when a strong wind is blowing into 
their mouths. For twenty-five years this backward and 
lateral pressure of sewer-gas had been a terror to the people 
of New York : to save themselves from it they had sub- 
mitted to most tyrannical laws, had suffered domiciliary 
visits from insolent officials, and they had been burdened 
with useless taxation. It might be thought that so soon as 
it was ascertained by experiments that there was no such 
pressure, those who made them would hasten to compose 
the fears of the people and relieve them from the useless 

* Sanitary Engineer, March 2, 1882. f July 11, 1 891. 



THE SEWER' GAS. I'J'J 

officials and burdensome taxation. Not at all. The author 
has sought in vain for a report of these trials by the New- 
York Board of Health and the Columbia College author- 
ities. A prominent official of that board writes to him, 
under date of September 21, 1891,"! am not aware that 
there has ever been published the results of the tests made 
in this office some years ago relative to the alleged pressure 
of sewer-gas from the public sewers, but it is true that a 
delicate gauge was placed upon the sewer connections in 
the office of the department, and careful observation made 
from day to day of the gauge, resulting in a failure to dis- 
cover any appreciable pressure." 

These experiments of Drs. Carmichael, Rozahegyi, Parkes 
and Burdon-Sanderson, Mr. Cramp, and Professor Chandler 
disperse completely the imaginary terrors of the sanitarians 
respecting the backward pressure of sewer-air. But, except 
by a few enlightened men like themselves, no heed was paid 
to their researches, or to those of Nichols, Haldane, Car- 
nally, and other scientific philosophers, who had preceded 
them, and who, with balance, test-tube, and microscope, had 
demonstrated physically — what all previous observations 
had shown — that there was no sewer-gas, and that sewer-air 
was free from disease-germs. 

The terrified public listened to the sanitarians. These 
made no counter-investigations to impeach the observations 
of the scientific men ; they did not even debate them ; some- 
times they assailed them with vituperation ; but, for the most 
part, snowed them under with wild tales of wholesale poi- 
soning by sewer-gas, revised sanitary codes, and malicious 
prosecutions. Plumbing laws were passed, and plumbing 
inspectors appointed in every city ; and statutes were made 
forbidding a man to introduce plumbing into his dwelling 
without the consent of the sanitarians organized as boards 
of health. 

Baffled and entangled by the evidence collected in their 



178 VAGARIES OF SANITARY SCIENCE, 

own reports, the flexible sanitarians again shifted theii 
ground and took a position behind the germ ; this, they said, 
got into the sewers, was borne upward on the gas, and 
forced past the traps into our houses. Light, they said, was 
now being shed on the pin-hole mystery; a single germ, 
endowed as it was with hermaphroditic power and energy, 
exuding from this orifice, could multiply itself hundreds of 
thousands of millions of times in forty-eight hours.* 

As before with th-e air, the water, and the soil, they made 
no investigations, but their imaginations actually ran riot, and 
they again mounted the witness-stand and caused damages 
to be assessed against innocent and respectable citizens by 
solemnly swearing that the sewers were loaded with gas, 
and the gas was loaded with the germs of disease. Scien- 
tific men had hardly begun their researches into the compo- 
sition of sewer-air when this evidence of the sanitarians was 
proved to be false. M. Miquel,t in 1882, declared, as the 
result of his experiments, that the danger from the spores 
which escape from sewers is not greater than that from the 
spores in the open air ; that often the confined and humid 
air of the sewers is purer than the air in those streets which 
are reported to be healthy. In the summer of 1880 the air 
in the wards of Hotel Dieu, although the hospital had been 
lately renewed and was carefully ventilated, contained six 
times as many bacteria as the air of the sewer beneath Rue 
Rivolij and in one week, from the 1st to the 7th of No- 
vember, the sewermen in this sewer were breathing only 
one-half the number of microbes that were inhaled by the 
passengers in the street above ; and in summer the atmos- 
phere of this street was always five or six times more 
impure from micro-organisms than that of the sewer. 

As we have seen on a previous page, experiments both 



* Popular Science Monthly^ vol. xxii. 
f Les Organismes Vivants. 



THE SEWER^GAS. 1^9 

with the cholera and typhoid bacilli showed that these germs 
lost their vitality and disappeared in sewers, just in proportion 
as these contained putridity. 

In " Comptes Rendus de la Societe de Biologie," 1889, is 
recorded in a few lines the experiments of M. Olivier with 
the water from a Havre sewer. Those specimens of this 
water which were sterilized, when sown with broth contain- 
ing typhoid bacilli, were swarming with these germs the next 
day. Those specimens which were not sterilized, but which 
retained the putrid bacteria, remained unaltered. 

Fliigge * says that the views respecting the influence of 
sewer-gas in producing typhoid fever and like diseases, 
which are in such a drastic manner brought out in EngHsh 
books, are entirely unauthorized {v'dllig unberechtigi). The 
infective action of sewer-gas is the less likely to take place, 
as this, by repeated examinations, is shown to be free or 
nearly so from germs which propagate these diseases, and 
because the continually wet sides of the sewers make it 
almost impossible for them to be set free. If by exception 
the germs of disease are present, all of the chances are 
against the possibility of their being the cause of infection. 
The action of sewer-gas, he adds, is no other than that of 
bad-smelling air ; and by ventilating the sewers this can be 
avoided. Professor Lehman f devotes, in his book of six 
hundred pages, only seventeen lines to the consideration of 
sewer-gas. He cannot conceive, he says, how typhoid fever 
can be produced by it, as it is always free, or nearly so, from 
bacteria [stets pilzarm oder pihfrei ist). 

As we have seen, the romance concerning the air, the 
water, and the soil, with which the sanitarians had cajoled 
the people, was only the prelude to a more exalted reverie. It 
is doubtful if the pages of the world's history can furnish a 



* Grundriss von Hygiene. 

f Methoden der Hygiene, 1S90. 



k 



l80 VAGARIES OF SANITARY SCIENCE. 

more striking illustration of the credulity of mankind than 
the sewer-gas dream. A pure creation, begotten in and 
floated from the sanitary brain without any investigation, it 
was, without examination, accepted and devoutly cherished 
by almost the entire people, wise and simple, of Great 
Britain and America, — a creation that, from the first, was 
viewed with contempt by scientific men of other countries. 
Pettenkofer said that it was as easy to show that infectious 
diseases had the same relation to lines of illuminating gas- 
tubes and telegraph-wires as to lines of sewers. Renk,* who 
made a special study of sewer-gas, declared that it was 
unpardonable nonsense (unverzeihlicher Leichtsinn) to claim 
that the contents of sewers had any relation to the causes 
of infectious disease. He could not conceive how men who 
work in, and continually breathe the air of, sewers should 
seem to be specially exempt from such disease, and people 
be made sick by the same air hundreds of thousands of 
times diluted. The French smiled at the new conceit and 
began early to train their wit upon it. Dr. Zuber f said the 
sewer-gas doctrine, more noisy and plausible than rational, 
was a transitory theory ; it would soon be forgotten ; and 
he asserted that there was not in epidemiological science 
a doctrine built on such a fragile basis ; that the rich collec- 
tion of anecdotes of sewer-gas ailments which the English 
displayed depended on their absence of method in etiological 
studies. 

There were in reality as many reasons and facts to 
show lunar influence in the causation of infectious disease as 
that it could be caused by sewer-gas. Notwithstanding that 
in every instance where the effect of sewer-gas on the human 
system has been studied on an enormous scale, it has been 
proved to be innocent; notwithstanding that in every in- 
stance — even in Great Britain and America — in which 

*Kanalgase. f Revue d' Hygiene, 1882. 



CEMETERIES. l8l 

scientific men have searched for sewer- gas with the most 
delicate apparatus, they have been unable to detect it, and 
have declared that it does not exist ; the sewer-gas night- 
mare has so oppressed the people of these two countries 
that they have submitted to the most offensive legisla- 
tion that was ever invented; they have endured odious 
domiciliary visits ; they have suffered persecutions and 
prosecutions without number; panics have been fomented, 
arrests have been made, fines imposed, damages as- 
sessed, and imprisonments threatened, to save the people 
from sewer-gas. Under the pretence of peril from this 
deadly gas, the citizens of nearly every large town in our 
country are compelled by most despotic laws to submit the 
plans of every prospective dwelling to a body of men, — 
sanitarians, — organized as boards of health, whose technical 
and mechanical knowledge is usually of the lowest order, 
and millions of dollars are spent annually to protect the 
people from a danger as imaginary as the dragon of ancient 
and mediaeval story. 



CHAPTER VIII. 
Cemeteries. 

Chronologically, the graveyard ghost was the first which 
the sanitarians erected to affright and torment the people 
about their health ; it preceded by nearly twenty years the 
sewer-gas bugaboo. 

In 172 1 an anonymous London author issued a small book 
entitled, " Seasonable Considerations on the Indecent and 
Dangerous Custom of Burying in Church-yards." He says, 
" It is an undoubted truth" that the corruption of dead bodies 
in churches may be communicated to the living, and that 
many fatal distempers may be received from the effluvia of 

16 



1 82 VAGARIES OF SANITARY SCIENCE. 

the dead, although the stench be not perceived. That a 
healthy man may impart strength to one that is feeble, is a 
matter of daily experience ; " nor is it a new discovery, for 
certainly this was the case with David, who, being decrepit 
and feeble, was cherished by a virgin that lay in his bosom.'* 
In the same way, dead bodies can bestow weakness and 
decay. The power of human bodies, our author says, is 
exercised not only on their own species, but on other 
bodies ; " for daily experience tells us that coral or amber, 
worn on a woman's breast, looks more bright or dull, more 
vivid or languid, according to the different degrees of her 
health." This sanitarian gives no more facts to sustain his 
argument, except to ask why it is that so many women faint 
in churches, if it is not from the stenches which arise from 
the graves. He demands that the practice of burial in vaults 
be forbidden. 

In 1839, G. A. Walker, a surgeon in London, published 
" Gatherings from Graveyards," which professed to inform 
the people of the dangerous and fatal results of burying the 
dead in the midst of the living. Mr. Walker says that in 
China two men began to dig a grave where a few months 
before a human body had been buried. The spade pierced 
the coffin, when both men fell down nearly lifeless. Though 
resuscitated, they had severe heat and pains in the liver, and 
died in four or five days after. He relates a story from the 
New York Gazette of Health, which was supplied by Rev. 
Dr. Render. In the month of July, 17 — , a very corpulent 

lady died at ; she was buried in the church. The 

next Sunday more than sixty people were taken sick at the 
communion service ; it was thought that the wine was 
poisoned and some arrests followed. The next Sunday a 
chalice of wine was exposed on the altar and soon " became 
filled with myriads of insects," and the rays of the sun 
denoted that they came from the grave of the corpulent 
lady. Four men were employed to open it, when two of 



CEMETERIES. 1 83 

them fell dead on the spot. " It was now clearly perceived" 
that this had caused the pestilence. 

A very fat man was buried in a church in Burgundy. Of 
one hundred and seventy persons who attended the burial 
and who entered the church, one hundred and forty-nine 
were struck with a malignant fever. The nature of the 
symptoms left no doubt that the malignity was owing to the 
infection of the cathedral. Mr. Walker tells us, " it was said" 
that in Paris in 1765 the air about the cemeteries was so 
infected that necessary aliments became tainted in their 
vicinity. 

In 1775 a curate breathed the infected air from a dead 
body while performing funeral rites, and contracted a putrid 
disease. Mr. Walker says, ** Ramazzini assures us that those 
who dig graves do not live long ;" and Haller relates that the 
exhalations from a single body, eleven years after burial, 
caused a dangerous disease in a whole convent. The soil 
of the cemetery in Portugal Street " is saturated, absolutely 
saturated, with human putrescence." The graves are dese- 
crated ; bones and heaps of coffin-wood lie on the surface ; 
the effluvia make people who live in the vicinity close their 
windows. Mr. Walker gives a list of forty cemeteries which 
are in bad condition. St. Giles's has the melancholy noto- 
riety of originating the plague in 1665. From official docu- 
ments he shows that from 1741 to 1837 there had been buried 
inside the metropolis two million one hundred and five thou- 
sand one hundred and twelve bodies ; and ten years later* 
Mr. Walker says that twelve-thirteenths of every dead body 
must dissipate and mix with the air we breathe. Some 
dreadful facts have now come to his notice; the bodies 
of four persons dead of cholera " were put into the ground 
against the floor-wall of a house, without an inch of earth 



* Journal of Public Health, 1849. 



1 84 



VAGARIES OF SANITARY SCIENCE. 



between them and the wall." He does not say that any bad 
results followed. 

The most remarkable feature of Mr. Walker's book is, that 
with the enormous number of bodies buried in these forty 
cemeteries, he should be forced to seek in China, Paris, and 
Burgundy for evidence to estabHsh his belief that burial in 
towns is prejudicial to health. He gives no instance of any 
epidemic or any single case of infectious disease having been 
caused by any of the cemeteries in London ; and he adds, 
" Our freedom from pestilence can only be ascribed to the 
natural or acquired power of resistance of its (London's) 
inhabitants, to favorable seasons, or to diminished tempera- 
ture." 

As the sanitary awakening had now begun, Mr. Walker's 
book excited a good deal of attention. A reviewer of it in 
the London Lancet * says, " There can be no doubt but that 
putrid exhalations from dead bodies in a concentrated state 
produce highly injurious and even fatal effects on the living 
subject." The Lancet tells " the frightful truth that in Lon- 
don alone a mass of human corruption, formed by nearly 
fifty thousand dead bodies, is annually deposited in the grave- 
yards, there by its putrefaction to contaminate the air which 
the living breathe, spreading fever and disease." A com- 
mittee of the House of Commons collected a large amount 
of " the most revolting but conclusive evidence," to show 
that these burials spread " a noxious pestilential poison over 
the metropolis." Of one of these cemeteries the Lancet says, 
" What a focus of disease such a burying-ground must be ! 
thick masses of remains, lying in a state of putrefaction, within 
a few inches of the surface of the ground." f " The facts which 
substantiate the pernicious effect of putrid exhalations are 
too numerous and too well authenticated to admit doubt ; 
for on two occasions the plague is said to have lingered in 

* London Lancet, vol. i., 1839-40. f Ibid., vol. ii., 1845. 



CEMETERIES, 1 85 

Paris longest near the cemeteries ; and there are numerous 
instances where the health of grave-diggers has been dis- 
ordered." " Not only are the emanations of the graveyards 
disseminated in the atmosphere, but the products of decom- 
position percolate the soil so as to pollute it to an immense 
distance." 

Petitions began to pour into Parliament to suppress burial 
in towns, it being " in many instances productive of injury 
to the public health, owing to the noxious emanations from 
the soil." 

In 1847 * is a report that the rector of Minchinhampton 
removed a thousand cartloads of earth from a church-yard 
and strewed it on grass-lands in the vicinity. " By a kind 
of poetical justice, typhus fever invaded the rector's family 
and destroyed his wife, daughter, and gardener." 

Through the inquiry made by the House of Commons, 
it was brought out that the laboring-people, though often 
living in one room, kept the corpses of their friends until 
putrefaction was far advanced. One undertaker testified 
that he had known bodies held for three weeks, and that 
every week he saw them retained until nearly putrid, al- 
though men, women, and children were living in the same 
room; that the smell from the coffin is often extremely 
offensive ; and that it is not uncommon '* for fluid decom- 
posed matter to escape from it into the street and to run 
down over the shoulders of the bearers." " In the metrop- 
olis, of the fifty thousand deaths that take place annually, 
twenty thousand occur in single rooms, each occupied by 
one entire family." A clergyman writes that the dead body 
with the poorer classes " is never absent from their sight. 
Eating, drinking, or sleeping, it is still by their side, mixed up 
with all the ordinary functions of daily life." It " is pulled 
about by the children, and is not seldom the hiding-place for 

* London Lancety vol. i. 
16* 



1 86 VAGARIES OF SANITARY SCIENCE, 

the beer-bottle or the gin, if any visitor arrives inopportunely." 
In a report made by Mr. Chadwick on the results of a special 
inquiry into the practice of interments in towns, great im- 
portance is attached to the fact that a number of deaths had 
followed the descent of men into vaults. Mr. Chadwick 
alludes to ** the cadaverous appearance of grave-diggers and 
all the other signs of a slow poison ;" and the evidence is 
such that " there can no longer be any doubt of the effects 
of air from church-yards on the inmates of neighboring 
houses," " In nine cases out of ten, the undertaker who 
has much to do with the corpse is a person of cadaverous 
hue." He says that Sir Benjamin Brodie mentions cases 
where students had taken small-pox in the dissecting-room. 
He quotes Dr. Copeland, who relates a case where a man went 
to church on Sunday; the next Tuesday the doctor was 
called to see him sick with a fever. The patient told him 
that when he was in the church he felt a rush of foul air. 
He died eight days later. Some years ago a vault was 
opened (he does not say where) in a church-yard, and a 
coffin burst. " So intense was the poisonous nature of the 
effluvia" that a great many people were seized with sick- 
ness. An undertaker had told him that he had known 
coffins to explode like the report of a small gun. " On the 
whole," he says, " the evidence tends to establish the gen- 
eral conclusion that offensive smells are true warnings of 
sanitary evils," and that these putrid emanations " furnish 
the principal cause of the most developed form of typhus ; 
that is to say, the plague." 

A chemist testified that gases from bodies would easily 
penetrate the soil and escape into the atmosphere, as was 
shown by coal-gas. Dr. Lyon Playfair affirmed that the 
"slightest inspection" showed that the putrid gases were 
not absorbed by the soil. He estimated that three million 
cubic feet of noxious vapors were yearly emitted from grave- 
yards, and must pollute either the air or the water in the 



CEMETERIES, 1 8/ 

neighborhoods ; and they have been known to pass through 
the sides of sewers, though these were thirty feet away. 

Some describe the odor of the graveyards as the " dead 
man's smell." 

Mr. Chadwick, however, says that all undertakers that he 
had seen *' state that neither specific disease nor the propaga- 
tion of any disease was known to occur amongst them from 
their employment. Neither the men who handle nor those who 
coffin the rejuains, nor the barbers who are called in to shave 
the corpses of the adult males ^ nor the bearers of the coffin 
are observed to catch any specific disease from it, either in 
their novitiate or at any other time!' " // is not known that by 
their infected clothes they ever propagate specific disease in 
their families or elsewhere!' ^'Neither does this appear to be 
observed among medical men themselves!' Mr. Chadwick 
passes by this direct evidence as if it were of no conse- 
quence whatever, and as if he could not see that, unex- 
plained, it contradicted and overturned all of the other 
testimony which he had offered. The condition of the 
public mind, however, was such that this direct and undis- 
puted evidence availed nothing against the anecdotes of the 
" corpulent lady," the " very fat man," and the " dead man's 
smell." One clergyman. Rev. H. Milman, had the candor 
to testify that the sanitary part of the question was most 
dubious, and rested on less satisfactory evidence than other 
considerations, — viz., the decency, solemnity, and Christian 
impressiveness of burials. 

In 1849* we are told that Sanitary Science has made a 
" gigantic stride ;" " churches are now considered under a 
double aspect, — a place of worship and a site of pollution by 
the festering bodies of the dead in the vaults beneath." As 
late as 1885 the same journal f declares that old burial- 
grounds are dangerous for children to play in ; that the 

* London Lancet^ vol. ii. f Ibid., vol. ii., 1SS5. 



1 88 VAGARIES OF SANITARY SCIENCE. 

germs of plague, cholera, and fever are lying there only dor- 
mant, but not extinct. It is most strange that with all this 
profusion of talk about " noxious effluvia," " pestiferous 
gases," deadly exhalations infecting air, water, and soil, not 
a single instance of disease or epidemic that can properly be 
ascribed to cemeteries is cited, except that in 1665 St. Giles's 
Cemetery had the notoriety of originating the plague. 
There is no proof that the two million one hundred and five 
thousand one hundred and twelve bodies interred between 
1 74 1 and 1837 did any harm to the people of London. 

Parkes * says, " It is a matter of notoriety that the vi- 
cinity of graveyards is unhealthy." " The air over ceme- 
teries is constantly contaminated (he does not say with what), 
and water which may be used for drinking is often highly 
impure." 

Tardieu says that Ramazzini deplores the fate of grave- 
diggers, their livid aspect, their sad countenance, and that 
he never knew one to reach old age. 

The sanitarians of our own country delight in conjuring up 
graveyard spectres. In a report on the Nyack Cemetery, the 
New York State Board of Health, 1885, p. 289, says, " It has 
long been a matter of experience that low fevers and various 
forms of filth diseases are apt to prevail in the neighborhood 
of old burying-grounds." Professor Lindsley, secretary of 
the Connecticut Board of Health,t says that the subject 
of cemeteries is one closely connected with the public 
health; that disregard of them had produced much evil. 
" The evidence on this point is overwhelming and unques- 
tioned." " The emanations from the graves of the dead 
after hundreds of years of burial have communicated to the 
living fatal maladies of which many have died." The sec- 
retary offers no evidence. Professor KedzieJ says that, 

* Hygiene. f Eleventh Report. 

% Fourth Report Michigan Board of Health. 



CEMETERIES. 1 89 

unfortunately, we have not to go abroad to learn the effect 
of graveyard water on the public health ; and he relates that 
a family at Grand Rapids had typhoid fever after drinking 
from a well near a cemetery. These "poor people," the 
professor says, ** were drinking a cold infusion of death." 
In the Twelfth Michigan Board of Health Report are the 
replies of twenty sanitarians to the question, " Do you 
regard the presence of a large cemetery in a city as detri- 
mental to the pubHc health ?" The board says it sought the 
opinions of " eminent sanitarians" on this subject. One 
replies, " Unquestionably detrimental." Another says, " I 
unhesitatingly answer in the affirmative ; for although the 
evidence is, to a large extent, indirect and inferential, yet it 
seems to me conclusive." A third answers, " As a rule, I 
would say, extra-hazardous." A fourth replies, " There are 
no circumstances under which proximity to a decomposing 
mass of animal matter can be devoid of danger to the 
living." A fifth says, " If one thing in Sanitary Science is 
better settled than another, it is that decomposing human 
bodies pollute both the air above the ground, the ground 
itself, and the water that percolates through the ground." 
Still another replies, " The universal judgment of sanitarians 
is that cemeteries should not be located" within a populous 
area. A seventh says, " Yes, emphatically, yes ; all expe- 
rience teaches that it is." Another writes, " I do regard the 
presence of a cemetery, large or small, in a city, as detri- 
mental, — yea, very dangerous to the public health." Though 
some of the answers were qualified, all to whom the ques- 
tion was addressed agreed as to the dangers of cemeteries. 
We have here some energetic vociferation, but not one of 
these authoritative replies is fortified by any evidence. 

Dr. David Warman,* in discussing cemeteries, rehearses 
the tale of the corpulent lady and other like stories. In 

* New Jersey Board of Health Report, 1883. 



190 VAGARIES OF SANITARY SCIENCE, 

addition, Doddsley's Annual Register for 1773 reveals to 
him that of one hundred and twenty young people who 
were receiving their first communion in the Church of St. 
Eustace, in Paris, all but six fell ill, also the cure and grave- 
digger. The illness was a putrid fever. But he says we 
need not search the pages of ancient history for facts to 
establish the noxiousness of cemeteries ; for during the 
Revolutionary War Trinity Church-yard emitted pestilential 
vapors, and in 18 14, from a lot on Broadway where was a 
potter's field, " most deadly effluvia arose." Still later, the 
Weehauken Cemetery, which had been in use for sixteen 
years, is said to be offensive ; Jacob Hausche, who resides 
on the north side of it, testifies that a very bad smell per- 
vades the whole neighborhood. Jacob " describes the smell 
as that of rotten carrion, extremely offensive." Dr. War- 
man says that both air and water are contaminated by 
cemeteries. 

Erichsen, in ** Cremation of the Dead," says that *' These 
are times that are trying men's bodies quite as much as 
their souls." " Zymotic diseases breaking out in what were 
once healthy villages may set even the blindest to seek for 
causes, and the most prejudiced may finally be forced to 
admit that the multitudinous graveyards are contaminating 
our water. New England villages, once so free from ills, 
are now taking on the air of invalids. People forget how 
they drink well-water the springs of which percolated 
through graveyards." Dr. Erichsen says, " Church-yard 
emanations can penetrate almost everything; they have a 
remarkable force." He quotes Dr. Marble, of Worcester, 
who says, " The monstrous delusion that the mere contact 
of the corpse with the fresh earth renders it innocuous is 
dissipated by overwhelming evidence." He also quotes 
Colonel Whitman, who says that the people in New Eng- 
land who deplore the advent of malaria, ** the unseen vam- 
pire that sucks the red blood of the present generation," 



CEMETERIES. I9I 

would do well to look about them and " see how the grave- 
yards, old and new, have grown in two centuries." 

The Eighth Report of the New York State Board of 
Health says the greatest danger has been noticed in ex- 
humations from old cemeteries, but specifies none. It re- 
lates that the Board of Education at Port Jervis bought the 
old St. John's graveyard on which to erect a school-house. 
The Board of Health interfered to prevent it. Dr. Carroll 
reported adversely to its use on account of danger to the 
public health, but the Port Jervis people proceeded to ex- 
hume the bodies, two hundred and thirty-five in all. The 
work occupied four weeks ; none of the persons engaged in it 
suffered any inconvenience. The Board of Health declared 
it was a source of danger to the children, and prophesied 
great disasters. They said that the soil here was of the 
nature to allow of the freest passage of gases, and that 
samples of the earth were swarming with bacteria, *' the 
invariable concomitants of putrefactive processes." 

So far we have numerous graveyard legends, an abun- 
dant supply of words about the mephitic gases, pestiferous, 
deadly gases, destructive effluvia, and the *' dead man's 
smell ;" we have the poor people who were *' drinking a 
cold infusion of death," an unlimited supply of the opinions 
of the sanitarians, " the matters of notoriety," the " unques- 
tioned and overwhelming" evidence, the '' settled principles of 
sanitary science," the " universal judgment of sanitarians," 
etc., etc., but not one particle of proof of a scientific char- 
acter. Indeed, not one of these sanitarians who so magis- 
terially offer their opinions and their averments about these 
" gases" claims to have made any experiments of his own ; 
neither does he offer the experiments of others to show that 
these mephitic, pestilential, deadly gases have any existence. 

During the prevalence of cholera in London in 1849, the 
Times overflowed with articles on the dangers of burial in 
towns. Disgusting stories were told of grave-diggers boring 



192 VAGARIES OF SANITARY SCIENCE. 

through the interred bodies to find out if there was more 
room in the earth ; of mutilated female corpses partly de- 
composed ; of coffins being tapped, which would " let out a 
jet of gas that burns from ten minutes to a half-hour." 
Old graveyards were said to be so saturated with these 
gases that they could hold no more ; and so, of course, they 
were emitted from the surface to be breathed. The graves 
were called " consecrated cesspools." One of these articles 
set forth the " dismal duty" of displaying the dangers of 
burial in metallic coffins, and directed ** the public gaze on 
the shrouded slumberer within." The writer says, " Gas- 
eous poisons are found so intense that their mere contact 
with a mucous surface of the body may occasion sudden 
death ;" that they burst the coffins, and the fumes emitted 
will destroy those who happen to be in the immediate vi- 
cinity ; and that " We have really only two alternatives as 
to the disposal of the resulting gases, — they must either be 
burned or breathed." Surely, the reader will say the Times' 
writer must have made some investigation, or, at least, have 
known of investigations by others, before he presented that 
communication to the public. But the fact remains that 
there had been no investigation. 

The article met the eye of Waller Lewis,* who says 
he hopes to see entombment prohibited in the cities and 
churches, but deems it important to lay before the public 
the result of his inquiries, which extended over many 
months in 1849-50. He was impelled to make these in- 
vestigations by the statements in the Times, He says that 
some of the allegations that cyanogen, hydrocyanic acid, 
sulphuretted, phosphoretted,and carburetted hydrogen gases 
were formed were so consonant with theory that one of the 
most eminent chemists in Europe, with whom he conferred, 
told him that he " was not prepared to deny any of the as- 

* London Lancet, vol. ii,, 185 1. 



CEMETERIES. I93 

sertlons in the Times, though he believed they were largely- 
theoretical." Unwilling to accept Dr. Playfair's " slightest 
inspection" as a proof of these gases, Mr. Lewis examined 
carefully between fifty and sixty vaults in the different 
churches in London ; he noted the external condition of 
more than twenty-two thousand coffins, and examined the 
contents of nearly one hundred. The results were so dif- 
ferent from what he expected, or from what is generally 
believed, that he was desirous of laying them before the 
profession. He says, ** I have never succeeded in obtaining 
any traces of the presence of cyanogen, hydrocyanic acid, 
sulphuretted, phosphoretted, or carburetted hydrogen, even 
in the smallest quantity." In the air of one vault was a 
trace of sulphuretted hydrogen, but there was no certainty 
that it proceeded from the bodies. "I examined gases 
formed by bodies of all ages, from the still-born infant to 
those which had survived the age of ninety-two." "Those 
which had been there for a week were examined, as well as 
those which had been there for a century and a half." 
Death had been caused by accident, age, and disease ; ty- 
phus, phthisis, small-pox, cholera. " Not one of the above 
circumstances seemed to influence, in the slightest degree, 
the composition or character of the gases." " All I ana- 
lyzed or otherwise examined were composed of nitrogen 
and carbonic acid, mixed with atmospheric air,, and holding 
decaying animal matter in suspension." The coffins do not 
burst. All of them do not even bulge. From the most 
searching inquiries of sextons and others, he obtained no 
evidence of the rupture of a coffin. He says that during 
this work, carried on in the stagnant atmosphere of these 
vaults, he sometimes had nausea and vomiting, throbbing 
pain in the head, and loss of appetite. A long time after 
he had boils and erysipelas. He does not say that he 
thinks the vaults were the cause of these disorders. 

In 1785 the bodies in the Cimetiere des hitioccnts in Paris 
\ n 17 



194 VAGARIES OF SANITARY SCIENCE. 

were exhumed.* This cemetery was old in the twelfth cen- 
tury ; it had been complained of for two hundred years as a 
source of disease and danger. It was said that the mephitic 
gases from it had penetrated the adjoining cellars in the 
vicinity, had collected on" the walls, and had been condensed 
there into a most subtle and deadly poison. By simply 
touching the wall it acted on the human system like the 
venom from the poisoned arrow of the savage. The gorged 
earth of this cemetery was swollen eight to ten feet higher 
than the level of the street. The number of bodies sur- 
passed all calculation : more than ninety thousand had been 
placed there during the thirty years anterior to 1785. M. 
Thouret says, here was an opportunity such as never before 
had occurred to observe changes in bodies, whether they 
were mouldering in heaps in a humble bed of earth, or 
proudly rotting apart in metallic coffins and stone vaults. 
All changes were noted, from the corpse which had dissolved 
in putrefaction to the more privileged one that was converted 
into a dried and fibrous mummy. The most distinguished 
families were confounded with the most inferior. ^'Cette 
espece dhommage rendu au principe degalite que la nature 
etablit parmi les homines devait flatter la multitude^ Be- 
tween fifteen thousand and twenty thousand bodies, in all 
stages of decomposition, were exhumed. Through fear, the 
labor was begun with great precaution, but afterwards it 
was carried on without any. The work lasted many months, 
being continued sometimes in the heat of summer. Not an 
accident happened to workmen or people, nor anything that 
could disturb the public. 

Parent du Chatelet f says that every year there are more 
than two hundred exhumations at Pere-la-Chaise, made at 



*. Sur les Exhumations du Cimetidre et de I'figlise des Saints Innocents, par 
M. Thouret. 

•}• Hygiene Publique. 



CEMETERIES. 1 95 

all seasons, and often two, three, and four months after death, 
when putrefaction is at its highest point ; and there is no 
record of any accident having occurred from these disinter- 
ments. Pellieux * expected to find " mephitic gases" in the 
cemeteries and vaults ; he found none but carbonic acid and 
small amounts of ammonia. He thinks that other gases do 
exist in cemeteries, and he hopes in future to demonstrate 
the truth of this theory. If he afterwards found them, he 
neglected to record his observations. 

Gaultier de Claubry reports f on the exhumation of the 
victims of July, 1830. Notwithstanding the difficulty of the 
work, the unfavorable temperature, the fatigue and bad odor, 
no one engaged in it suffered serious inconvenience. Five 
hundred and seventy-four bodies were exhumed. They were 
in all conditions, from dry bones, in some of the places, to the 
most absolute putrefaction in others, varying according to the 
soil and the quantity of bodies massed together. 

Dr. O. du Mesnil says, for speculative purposes, the public 
health had been invoked to have a single cemetery estab- 
lished at Mery-sur-Oise, and to have the cemeteries in Paris 
closed. This involved an outlay of nearly thirty million 
francs. Dr. Du Mesnil % says that our present knowledge 
assures us that the contamination of air, water, and soil 
from cemeteries is pure hypothesis. The experiments of M 
Schultzenberger with three specimens of earth — one from a 
virgin soil, one just over and one just under a coffin from 
\}i\^ fosses communes — proved that the combustion of a body 
was complete five years after burial ; and that from the pres- 
ent mode of burial there is no danger of saturation of the 
soil. In none of the examinations of air, either on the sur- 
face or from one to two and a half feet below, could a trace 
of sulphuretted hydrogen, ammonia, or oxide of carbon be 
found ; and it was proved that bodies buried four and a half 

* Annales d'Hygi^ne, 1849. f Ibid., 1843. X ^^^^-y 1866. 



196 VAGARIES OF SANITARY SCIENCE. 

feet in the ground are consumed in five years, without disen- 
gaging any gas that can affect the public health. In 1879 
M. Schultzenberger * took air from the cemetery at Mont- 
parnasse at a depth of from one to two and a half feet, over 
graves many years old, and over graves six months and a 
year old. At no time could he find any gases except nitro- 
gen, oxygen, and carbonic acid. 

M. Carnot examined twelve specimens of water from six 
different cemeteries in Paris. He found a strong proportion 
of sulphate and carbonate of lime, with slight amount of 
salts of magnesia and alkaline chlorides ; but no traces of 
organic matter , with one exception^ and this was where the 
well had been long unused. The usage of these wells, says 
Dr. Du Mesnil, by the inhabitants around, by the workmen, 
and by visitors, for centuries, furnishes the best answer to 
the accusations against them. G. Robinet.f in a thesis sus- 
tained before I'Ecole de Medecine, on the pretended dangers 
of cemeteries, says that the decomposition of bodies in the 
earth is an organic combustion ; the final products are car- 
bonic acid, ammonia, and nitrates. He estimates the weight 
of bodies buried in Paris annually at about three miUion 
pounds ; fifty-six per cent, of these is water, fifteen albuminous 
matters, twenty-one fatty matters, and eight per cent, ashes. 
According to his investigations, the transformation of all the 
carbon contained in these bodies into carbonic acid would 
make nearly three million pounds of this substance. As the 
daily production of carbonic acid in Paris by men, animals, 
and different sorts of combustion is more than fifteen million 
pounds, it would take five years for the bodies buried in Paris 
to produce as much carbonic acid as is formed in one day by 
the living in that city ; and the talk about " certains gaz,'' 
^'certains produits volatils*' is imaginary. That ammonia 
may be found, he admits ; but it is found everywhere in 

* Revue d' Hygiene, 1884. f Paris Theses, 1880. 



CEME TERIES, 1 97 

nature, and is harmless. What are called miasmes do not 
exist in cemeteries, except as we can apply the term to micro- 
organisms. All experiments in exhumation prove that the 
soil does not become saturated with either solids, Hquids, or 
deleterious gases; that the water of wells near cemeteries 
has been proved by experience and by chemical analysis to 
be innoxious ; that analyses of soil in and near graveyards 
show the same result as arable soil elsewhere that has never 
been infected. 

In Annates d' Hygiene, vol. ii., 1884, is a report by Dr. O. 
du Mesnil on soil containing organic and decomposing mat- 
ters, particularly the soil of cemeteries. The 2 1 st of August, 
1883, on the occasion of a burial at Montparnasse, a work- 
man descended into a caveau and was suffocated. In the 
attempt to rescue him, three other laborers came near losing 
their lives. An architect was ordered to examine and report. 
He advised that energetic measures be taken to disinfect this 
soil, from which fetid emanations proceeded, endangering the 
health of workmen and even of that quarter which surrounds 
the cemetery. 

Dr. Du Mesnil says it might be supposed that, in view 
of the counsel of such radical measures, some examination, 
some analyses of soil and air had been made. Not at all ; 
not a single experiment with either had been undertaken. 
The government appointed a commission to investigate. In 
that part of the cemetery where the accident had occurred two 
caveaux were dug, about fifteen feet deep, separated by a space 
of twelve feet. They were bricked up in the ordinary way with 
cement, and covered. In less than twenty-four hours they 
were opened and a laborer descended. In a few moments he 
called to come out ; bad air, he said, was in the cavcmi. A 
lighted candle let down was extinguished eight feet from the 
surface. The pit was filled with carbonic acid gas. In none 
of the analyses of the air was there a trace of sulphuretted 
hydrogen, nor of carburetted hydrogen, nor of oxide of 

17* 



1 98 VAGARIES OF SANITARY SCIENCE. 

carbon. The proportion of oxygen was always very feeble ; 
it and carbonic acid oscillated, according to the temperature. 
The commission concludes : First, that in any excavations 
in a soil where are decomposing organic matters, whatever 
may be their origin, two phenomena occur to put life in 
danger, — the rapid and free disengagement of carbonic acid, 
and a notable impoverishment of oxygen. Second, that 
these modifications of the air are limited strictly to the exca- 
vation, and have no influence on the neighboring inhabitants. 
The commission say that between 1863 and 1883 there were 
three hundred and sixty-seven thousand eight hundred and 
eighty-four descents into the different caveaiix, without in- 
commodincr a single workman. 

o o 

In 1883 M. Miquel published the result of his investiga- 
tions of the air of cemeteries, and of the germs which he 
found in them. He proved that the number of microbes in 
the air at the cemetery of Montparnasse, even in times of 
drought, was very much less than in the streets of Paris, and 
he adds, " If it be proved that the soil to which is confided 
the vast numbers of the dead is incapable of emitting nox- 
ious germs, these vast fields of mourning, on which rest so 
many unjustifiable accusations, will be not only innoxious 
but will be a sanitary agent {tme cause a' assaiiiissemeni) for 
the great cities, like public gardens, wide passages, and spa- 
cious courts, which permit the winds, the purifying agents, 
to accomplish their mission." M. Miquel made most care- 
ful and repeated, but unsuccessful, experiments to ascertain 
if a single germ passed out of the soil of cemeteries. 

Dr. Reimer,* after investigating the Jena church-yard, con- 
cluded that the buried body exercises no important influence 
on the number of bacteria in ground near it ; that bacteria 
disappear almost entirely at a depth of from three to six 
feet. Neither near nor under the coflfins in the Jena grave- 

* Zeit. fur Hygiene, 1889. 



CEMETERIES. 1 99 

yard was the number of bacteria greater than at correspond- 
ing depths elsewhere, and it made no difference whether the 
body had been buried thirty-five years or only eighteen 
months. 

In the sixth report of the Massachusetts Board of Health 
is a paper by Dr. J. F. Adams, on " Cremation." He sent a 
circular, to which he received one hundred and seventy-one 
replies — one hundred and thirty-one from Massachusetts — 
to the question whether cemeteries were a cause of ill 
health. This time the query was directed, not to profes- 
sional sanitarians and health officers whose standing as 
scientists and whose subsistence depended on perpetuating 
a panic among their fellow-citizens, but to physicians en- 
gaged in the daily practice of medicine, who had neither 
inclination nor interest to excite alarm in the communities 
where they were located. Of the one hundred " and thirty- 
one replies from Massachusetts, five said " Yes ;" one hun- 
dred and twenty-six said " No." Thirty-two replies were 
received from other States. Three said " Yes," twenty-nine 
said " No." Dr. Adams says, " In searching for cases of 
recent date, of disease resulting from graveyard infection, 
we find that such are almost unknown to medical literature." 
After citing a number of wells (before alluded to, p. 1 19), he 
says, " After a diligent inquiry, we have been unsuccessful 
in obtaining a single example of disease presumably in- 
duced by water contaminated by the proximity of burial- 
grounds." He adds that the danger to health from cem- 
eteries is " utterly insignificant. A living man in sound 
health is far more to be dreaded than is a dead man buried 
with ordinary care." Professor Rohe * says, " An unpreju- 
diced consideration of the subject (cemeteries) shows, how- 
ever, that there is no trustworthy evidence that any of the 
gases exhaled by decaying or putrefying bodies are injurious 

* Hygiene, 1890. 



200 VAGARIES OF SANITARY SCIENCE. 

to health." He asserts that the dangers from pollution of 
water by cemeteries have been over-estimated, and that there 
are no facts on record which show that infectious diseases 
are propagated from interred bodies. Fleck,* in his exami- 
nation of the water of wells in Dresden, found no proof of 
ill effects of the use of such water. Neither the period of 
interment nor the closeness of the graves had any influence 
on the contents of the wells. 

At the International Hygienic Congress at Vienna, Pro- 
fessor Franz Hoffmann f offered a paper on the sanitary dan- 
gers of graveyards. He said that not only the laity but 
great numbers of experts and writers maintain that emana- 
tions from buried bodies breed disease among the living. 
That men have been asphyxiated on account of descending 
into tombs, he admits. The same accident has attended 
descents into wells ; but nobody is buried in wells. He de- 
clares that there are no gases in graveyards perceptible to 
the senses. The bacteria of putrefaction work with great 
energy ; he had seen thirty-five per cent, of the soft parts 
of a child disappear in less than two months after burial. 
The objection that the germs of typhoid fever and other 
diseases are retained in graves is altogether unfounded. 

Dr. Sigel said that numerous {zahlreichen) experiments 
which he had made with Dr. Hoffman in the exhumation 
of bodies during the last eight years had entirely changed 
his views respecting cemeteries. Before that he had stood 
on the ground of those traditions which might be called the 
legends of graveyards. He had seen large numbers of ex- 
humations, two, three, four, and five years after burial ; he 
never knew any accident to happen to assistants or to people 
in the vicinity. In Saxony, Dr. Sigel said, an investigation 
had been held to determine whether the laws could be mod- 



* Appendix to Prof. Nichols's report on ground-air. 
t Viert. fur Oefft. Gesund., 1882. 



CEMETERIES. 201 

ified with safety, which demanded a protracted interval of 
time between the burial of one body and that of another in 
the same ground. Twenty-eight physicians, to whom the 
investigation was assigned, reported, without any concert, 
that no danger to the public health would arise from a re- 
laxation of those laws. 

Dr. Rozahegyi said that his investigations had been made 
in the cemetery of Budapesth, where were from one hundred 
and eighty thousand to one hundred and ninety thousand 
bodies. The earth here is astonishingly active in oxida- 
tion, and the bodies defile neither the earth nor the water. 
Of fourteen specimens of water in the cemetery, compared 
with fifty-nine in other parts of the town, the former were 
the purer ; and that the water from wells in the cemetery 
did no harm was confirmed by the comparative freedom 
from zymotic disease of those who drank it. These papers 
produced a profound impression on the conference. Dr. 
Kuby considered them as a blow in the face {einen Faust- 
schlag in das Gesicht) of sanitary authorities, who had fos- 
tered the cemetery bugbear for a thousand years. Fliigge * 
says that it is impossible in a well-regulated cemetery that 
the ordinary process of the decay of bodies should do any 
harm ; that no specific gases, no so-called corpse-gases, are 
formed. He admits that a bad smell may arise from large 
masses of imperfectly-interred bodies, but declares that the 
absorption of these odors in a regular cemetery is complete ; 
that contagious diseases never arise from a buried body ; 
that it is impossible for the infective bacteria to escape from 
the ground ; that according to many experiments the water 
of wells in graveyards is purer than that of wells in the 
same towns ; and that it is not possible for the contagious 
microbes to escape into the wells of church-yards. 



* Grundriss von Hygiene. 



2 02 VAGARIES OF SANITARY SCIENCE. 

There are thirty-five cemeteries in New Orleans ;* nineteen 
are within the city. Many of these are " situated in the 
heart of populous districts." In many places in New Or- 
leans water is struck eighteen inches below the surface, so 
that burial in vaults is largely the practice there. For the 
fifty years ending in 1883 there had been 272,649 burials 
in the thirty-five cemeteries; 47,622 died from infectious 
diseases. Dr. Holt,t formerly president of the Louisiana 
Board of Health, says that the stench from human bodies in 
these graveyards pervades the houses. In Locust Grove 
Cemetery the pauper graves receive the bodies of many 
dead. A grave is opened, a coffin broken into, the bones 
are raked out, the old coffin broken up, pried out, and a new 
one put in place ; the lid of the box only two inches below 
the surface of the soil. Flies swarm back and forth from 
the graves into adjoining houses and upon tables. Dr. 
Holt does not say that he ever knew or heard of a case of 
disease or an epidemic arising from these cemeteries. 

Dr. Joseph Jones,J on intramural burial, says that in 1801 
a Capuchin priest petitioned for the removal of one of the 
cemeteries, because it was a menace to the public health. 
This is the only evidence that the doctor offers in his short 
paper to show that any one in New Orleans ever suspected 
that these cemeteries were a source of disease. He has spent 
a large part of his life in that city, and has had better 
opportunities for obtaining information respecting its salu- 
brity than almost any other observer; yet he does not say 
that he ever knew or heard of a case of disease or an epi- 
demic arising from these cemeteries. He gives no opinion, 
although he may perhaps have the opinions of the twenty 
sanitarians before him which are recorded on p. 189. As a 



* Louisiana Board of Health Report, 1880-83. 

f Sanitarian^ vol. vii. 

X Louisiana Board of Health Report, 1882-83. 



CEMETERIES. 203 

preliminary to the formation of an opinion, Dr. Jones sug- 
gests what ? That a thorough investigation be made of intra- 
mural burial ; and that the inquiry should embrace the 
nature of the soil of cemeteries ; the effects of seasons ; the 
chemical and physical properties of the gases exhaled ; the 
nature of the organisms developed ; the effects of putrefac- 
tion, etc., etc. If it be permitted to judge Dr. Jones's char- 
acter from his printed works, it is not hazardous to say 
that when the conditions of his proposed investigation shall 
have been complied with, he will form an opinion and be 
ready to express it on proper occasions, so as not to be 
misunderstood. 

The pensive wanderer through and about the crowded 
cities of the dead on Long Island seeks in vain from those 
employed there, or from the inhabitants near them, for any 
other than a negative reply to the question whether labor 
among these tombs or residence in their vicinity is preju- 
dicial to health. Many of those to whom the query is 
put treat it with mild contempt. Nobody but the sanita- 
rians seem to know that cemeteries or their surroundings 
are unhealthy, and their knowledge is not obtained by inves- 
tigation. Did they acquire it by revelation or intuition ? 

In the old Cavalry Cemetery are two wells. One is lo- 
cated in a valley-Hke depression surrounded by graves, the 
nearest of which is only three feet away. Within six feet 
there are a dozen, and within twenty feet there are fifty 
tombs. The water of this well is drunk habitually by the 
workmen in the cemetery, and daily in the warm season by 
hundreds of people who visit the church-yard. The work 
men in this part of the yard praise the water highly. They 
say that of the other well, which is on the hill, somewhat 
remote from the graves, is likely to cause cramps, if taken 
too freely in summer. But this, in the valley, is a guileless 
water. Inquiries, however, about the well on the hill, which 
is fifty feet from a grave, bring out just as positive testimony 



204 VAGARIES OF SANITARY SCIENCE. 

as to its virtues. The workmen and the visitors who par- 
take of this water deny the impeachment that it ever causes 
cramps. The clergyman at the church, which is near, casts 
no aspersions on the well in the valley, but affirms with 
energy that the water of that on the hill equals in every 
respect that of the one below, which is so close to the 
graves. * 

The well in the Lutheran Cemetery is about one hundred 
feet from the graves. Its water is so abundant and so 
precious that in times of drought the neighbors come for it 
from a long distance. Two wells are located between the 
Jewish and Cypress Hills Cemeteries, about one hundred 
feet from the graves. The water of both is sought after by 
the people around, when their own supplies fail, and is not 
only regarded as delicious, but is proved by long experience 
to be healthful. 

Beneath the Church of Santa Maria della Concezione, in 
the city of Rome, are four mortuary chapels, adorned with 
the bones of more than four thousand (so the guide-book 
says) Capuchin monks, that have died in and been deposited 
beneath the monastery, since its foundation in 1624. In these 
chapels are seen uncoffined bodies in various stages of dis- 
solution. When a new inhumation is made, the bones 
which have lain the longest are employed to decorate one 
of the chapels. The ghostly father who, three years ago, 
conducted the author through the gloomy cloisters and into 
the charnel of this abbey, when asked if such entombment 
of these bodies ever had any influence in impairing the 
health of those who ate, drank, worked, and slept over and 
around them, raised his brows in mild surprise and an- 
swered, " No." How many had here been entombed. He 
could not tell. As many as four thousand ? " Many, many 
more." 



PUBLIC FUNERALS. 20$ 

CHAPTER IX. 
Public Funerals. 

Analogous to the Graveyard Ghost, but somewhat 
later, the sanitarians presented a new terror, — that of 
public funerals. There was no more direct, scientific proof 
to implicate the newly-dead body in the production of 
disease, sporadic or epidemic, than there was to so connect 
the one which was far advanced in putrescence. Indeed, 
during the research in England concerning intramural burials 
the question of contagion from the unburied dead was 
hardly alluded to. The whole scope of that investigation 
was only to establish the belief that bodies in their progres- 
sive decay, after burial, emitted noxious gases which excited 
disease. The positive testimony which Mr. Chadwick pre- 
sented in his report (and which, unexplained, seems to over- 
turn that of all other witnesses), — namely, that undertakers, 
sextons, bearers, barbers, all who had anything to do with 
the preparation of the corpse for burial, never either became 
infected themselves, nor by their bodies or clothing ever 
infected others, — these observations, too, extending for gen- 
erations, — would seem to settle beyond a doubt the non- 
contagious property of the recently-dead body. 

But the public mind, constantly kept in agitation by the 
sanitary terrorists, was always open for the reception of 
new apprehensions of evil, and the excitement about the 
cemeteries had hardly subsided when they seized the oppor- 
tunity to widen their dominion by frightening the people 
respecting public funerals, and persuading them to yield to 
boards of health the power to prohibit such ceremonies. 

The tender sentiments which had pervaded every people, 
barbarous and civiHzed, since the beginning of time, regard- 

x8 



206 VAGARIES OF SANITARY SCIENCE. 

ing care for the dead, must now in a great measure be sup- 
pressed. The sanitarians, as usual, without making any 
investigation, began with pontifical solemnity to exhort the 
people against the dangers of public funerals ; and it soon 
became one of the " settled principles of Sanitary Science" 
that the body dead of any contagious or epidemic disease 
could communicate the same to the living. 

The Mosaic hygiene, which the reformers had so rever- 
ently held up for us to imitate and admire, sustained them 
in this instance, for it was written that whosoever touched a 
dead body should remain apart and unclean for seven days. 

Tardieu * says that there is no doubt that bodies dead 
from contagious diseases can communicate the same ; not- 
ably those diseases which are transmitted from animals to 
men ; though he gives no example. Arnould f says it is 
difficult to conceive a more unhealthy object than a dead 
bodv among the living'. Were it not for the sentiment of 
rehgion, we would instinctively withdraw ourselves from it, 
even when there is no fear of contagion. Thousands of 
experiments have put beyond doubt the deadly energy of 
the ^'poison septiqiie!' In fact, he says every organism that 
life has abandoned is immediately invaded by the formidable 
phenomena of putrefaction. He gives no example of the 
deadly energy of the ^' poiso7i septique!' It is related in the 
Second Report of the New York State Board of Health 
that an undertaker laid out two children and carried home 
the infection to two members of his own family. In the 
Fourth Report of the New York State Board of Health is 
an account of diphtheria at Indian Lake ; a pubHc funeral 
was held and the disease spread. The same disease is re- 
ported at Arietta as having been brought there by two 
members of a family who had slept in a bed at Johnstown 

* Dictionnaire d'Hygiene, article •' Contagion." 

\ Nouveaux Elemens d'Hygiene. 



PUBLIC FUNERALS. 20/ 

in which a child had died of diphtheria two weeks before. 
In the Ninth Report of the Massachusetts Board of Health 
it is recorded that a man attended a public funeral of a child 
dead with diphtheria ; after returning to his home " his two 
children were taken ill and died :" the account does not say 
what other exposure there was, or how long after the return 
of the father the children were taken. The same report 
says a mother laid out these children, took the disease, and 
died. Again, it is related that diphtheria broke out at 
Winchendon ; '* four children in one family, being the first 
cases that had occurred in the town for several years, died." 
" Out of forty who attended the funeral, thirty-seven took 
the disease." At Webster a child died of diphtheria. " At 
the end of three weeks sixteen of the children who attended 
the funeral were down with the disease." At Rockport " a 
corpse dead from scarlet fever, brought from abroad, was 
exposed in the church. There was then no case in the 
town ; but a few days after (how many is not stated) one 
who attended the funeral and was near the coffin was struck 
down with the disease." The report does not say if any 
others who attended the funeral were seized with the disease. 
This report of the Massachusetts board, which records these 
cases, says, however, " It is an open question whether in the 
cases enumerated the contagion was received directly from 
the cadaver, or whether from some one or more of the 
accessories" of a funeral ; those who are associated with the 
sick being " more active distributors of the poison than the 
corpse ;" and it adds that some of these cases were obscure 
enough to lead physicians to the belief that the disease in 
many of them was started de novo. Rev. S. Bridenbaugh, 
in a paper read before the State Sanitary Convention at 
Norristown, Pennsylvania, cites three instances where dis- 
ease was communicated through public funerals ; but these, 
like all of the others, are so carelessly reported that they 
have no scientific value. In all of the places except Win- 



208 VAGARIES OF SANITARY SCIENCE, 

chendon and Rockport epidemics were prevailing. At 
Winchendon diphtheria had been absent for " several years" 
anterior to the seizure of the four children, and these cases 
were probably the beginning of an epidemic that had no 
reference to the public funeral. The Sanitarian, November, 
1890, reports that a child died in Wilmington, Delaware, 
the physician who attended the case certifying that the 
death was from pneumonia. The body was transferred to 
Prospect, Maryland, and the coffin was opened. A few 
days after, how many is not stated, diphtheria broke out in 
Prospect. To admit this as a case of contagion at a public 
funeral, we must assume that the physician made a false cer- 
tificate, apparently without any motive. There is no record 
that diphtheria was prevailing at Wilmington. The author 
has inquired carefully into the circumstances of this case, 
and can affirm that there is no proof that the child died of 
this disease. The undertaker declares that it did not die of 
a contagious disorder, and, except that there was a " report" 
that the case was one of diphtheria, and that the family was 
" reticent" after the funeral, there is no evidence whatever. 
Yet this case has gone into sanitary literature, to be quoted 
by sanitarians in future as positive proof that a public 
funeral may communicate contagious disease. 

It must be kept in mind that all of these cases are re- 
ported by those most interested in creating and sustaining 
panics ; but, allowing all of the significance that the sanir 
tarians wish to derive from them, it is plain that the pro- 
hibition of public funerals in such cases can accomplish 
nothing to prevent the spread of epidemics, unless all who 
have been connected in any way with the deceased while 
passing through the sickness are quarantined for a period of 
time which has not yet been defined. Except one or two 
apocryphal cases, to be afterwards alluded to, the author 
has found none reported in the medical journals that would 
indicate that there is any danger from the body dead of 



PUBLIC FUNERALS. 209 

contagious disease. In reality, the conductor of a respect- 
able medical journal would not admit to its columns, with- 
out quahfication, these accounts of cases of contagion at 
funerals, which are welcomed and bruited by the sani- 
tarians. 

In 1 83 1 Parent du Chatelet* and M. D'Arcet were ap- 
pointed to examine the salles de dissection in Paris. They 
say that up to the beginning of the present century dissec- 
tions were carried on privately in different parts of that city ; 
about that time they were forbidden, except in certain insti- 
tutions. In six of these Parent had studied anatomy for 
five years ; a very large number of young men were under 
his observation; in spite of the crowding of bodies and 
of students, in spite of continued labor of three, four, or 
more hours daily over the bodies, he could find no proof 
that the emanations from them — dead of all sorts of dis- 
eases — had ever any influence on their health. He had 
seen young men indisposed, and even fall sick during their 
studies with dyspepsia, general malaise, colics, and diarrhoea ; 
but they were spontaneously cured in a few days, and the 
same disorders prevailed among the students of other pro- 
fessions in Paris. Of the medical students not more than 
one in ten or twelve were ever even indisposed, and they 
were as often so in summer when dissections were not going 
on. Parent was one of four hundred students who dissected 
at one place in 1 8 1 2 ; not one of these was sick that year. 

Nothing, he says, could be more foul or more crowded 
than the amphitheatre of the Hotel-Dieu ; one hundred and 
fifty students worked here ; he could find no proof that any 
illness occurred among them. Lallemand observed the 
same facts, and cited Desault, who said that those who fre- 
quented the hospitals were often taken sick with contagious 
disease, while those who frequented the amphitheatre were 



* Hygiene publique. 
18* 



2IO VAGARIES OF SANITARY SCIENCE. 

exempt. Desault expressed his opinion — founded on ob- 
servation — of the harmlessness of a body dead of contagious 
disease, in the axiom, " morte la bete^ mort le veniny Boyer, 
who directed crowds of students, Professors Dubois, Ribes, 
Dupuytren, Roux, Dumenil, Beauchene, Jadelot, Serres, 
Breschet, and Andral testified to the same effect. Serres 
had charge of La Pitie for sixteen years, where were dis- 
sected twelve hundred bodies annually by six hundred 
students, all or nearly all young men. He declared that, 
except a slight diarrhoea, he had never known any illness 
among them. Dr. J. C. Warren * says that he had seen, 
both in Paris and in Edinburgh, students in great numbers 
— some of them in delicate health — devoting long hours at 
a time to dissections, enduring great fatigue, opening bodies 
dead from typhus and yellow fevers in hot weather, and 
when epidemics were raging, without any harm having 
come to them from this work. He had made many in- 
quiries of sextons and undertakers in Boston regarding con- 
tagion from dead bodies. They all agreed that they knew 
of no instance where fever had been communicated in this 
way. Dr. Warren quotes Professor Lawrence, who for ten 
years had observed the students at St. Bartholomew's Hos- 
pital, and who declares that he never knew a case of illness 
to occur from anatomical studies. Tardieu, who is so posi- 
tive as to the communicability of sickness from the dead 
body when he discusses contagion, does not, in his article, 
Amphitheatres de Dissection, try to controvert Parent du 
Chatelet's conclusions. He only claims that the dissecting- 
rooms should be under surveillance on account of the in- 
terests of neighboring proprietors. Dr. Gull f says, *' Those 
who were engaged in making post-mortem examinations of 
cholera subjects seemed to incur no risk of thereby taking 

* Boston Medical and Surgical Journal, 1829. 

t Report of Royal College of Physicians on Cholera of 1849. 



PUBLIC FUNERALS. 211 

the disease." Dr. Allison * says, " It is certain that the 
dissecting-rooms in Edinburgh were supplied during the 
greater part of 1848 and 1849, as they were in 1852, almost 
exclusively by cholera subjects, and in neither was there a 
single case of the disease among the numerous students 
attending these rooms." In the Lancet, vol. i., 187 1, Mr. 
Samuel Wilks, surgeon, calls the attention of the medical 
profession to the terror which is spread abroad regarding 
contagion from the dead body. He says, "There is no 
harm in the segregation of the dead, but do not let scientific 
men act solely on false popular fancies." He gives his 
"opinion framed from negative evidence," that all fear of 
contagion ceases with death. At his hospital he had seen 
students take typhus fever after a slight exposure to a case 
in the wards, while fifty students would pass a whole hour 
over the same body, in a small room, making a post-mortem 
examination, without harm ; and he thinks there is no reason 
to believe that emanations from a corpse can produce dis- 
ease. Dr. Ewens f writes that Dr. Wilks's letter has " com- 
pletely upset" all his previous views ; that for twenty years 
he had urged the early interment of persons dead of conta- 
gious disease, under the impression that the risk of infection 
was great, and that his labors had been ineffectual. " I am 
compelled honestly to admit that, in spite of solemn protes- 
tations against such practices, I cannot recall to mind a 
single instance in which there was any good ground for 
supposing that the dead body did the mischief anticipated." 
Messrs. Hawkins and Hovell % believe that they have seen 
small-pox communicated by dissecting bodies dead of that 
disease. One correspondent in the Lancet offers no facts to 
disprove Dr. Wilks's views, but regrets their publication, — 
not because they are false, but because it will weaken the 

* British and Foreign Medico-Chirurgical Review, 1854. 
f London Lancet, vol. i., 1871. % Ibid. 



212 VAGARIES OF SANITARY SCIENCE. 

hands of those who advocate the establishment of mortuary 
houses in crowded cities ; and he adds, with charming sim- 
pHcity, that he fears he will " not have so good a case" in 
his efforts to establish one of them. A number of hearsay 
stories were brought out by Dr. Wilks's publication, among 
others that of a girl who died of enteric fever ; the carpenter 
who made the coffin was seized with sickness immediately 
at the time of placing the body therein, and died of that 
fever. Like Dr. Ewens, the author has made many " sol- 
emn protestations" against public funerals, which were un- 
heeded. He can call to mind numerous instances of severe 
disease of an acute inflammatory type, which probably had 
for exciting causes exposure to cold and wet at funerals. 
He can remember no case of contagious disease which was 
ever communicated by public burials. He has conferred with 
many physicians of wider experience than his own, and has 
found none who could remember a single case of contagion 
from a funeral. In conversing on the subject with an octo- 
genarian in New York, who was a practitioner during the 
cholera of 1832, the veteran at first was impatient that any 
one should doubt the danger of public funerals, but when 
pressed for his experience said, " If you ask me to put my 
finger on a case, I cannot do it. The subject is worth look- 
ing up to see if there is danger from them." The author 
has inquired of many pathologists who have been engaged 
for many years in making autopsies on bodies dead of all 
kinds of contagious diseases ; many times in these operations 
they have been surrounded by large numbers of young 
men who were more than ordinarily susceptible to conta- 
gion by reason of age, and who have often been permitted 
to handle the diseased organs. None of the pathologists 
offer an instance to show that infection can be spread by a 
dead body, but each affirms his belief that such contagion 
cannot occur. The author has the testimony of ten under- 
takers located in four cities of one hundred thousand, two 



PUBLIC FUNERALS. 213 

hundred and fifty thousand, eight hundred thousand, and 
one miUion six hundred thousand inhabitants respectively, 
whose business experience varies from seventeen to fifty 
years. Some of them have known of the celebration of 
many wakes over the bodies of those dead of infectious dis- 
eases. None of them can remember that any ill effects 
ever followed these ceremonies. All say that they or their 
employes never take any precaution against contagion when 
called on to officiate ; and all except three unite in expressing 
their belief that a body dead of any contagious disease is in- 
capable of communicating such disorder to the living. Each 
of the three exceptions was an undertaker who had a case in 
mind where one of his employes was seized with variola a few 
days after burying a body dead of small-pox, though all of 
the three admitted that the disease was prevailing at the time. 
The remaining seven were as confident that small-pox could 
not be imparted by a body dead of that disease as they were 
that other diseases could not be so communicated. 

The international conference which reported on the chol- 
era of 1865 * says there is no proof that the body dead of 
cholera can transmit the disease ; it is only prudent to con- 
sider it dangerous. 

At a meeting of the Suffolk District Medical Society, 
April 29, 1876,1 a committee, to whom the subject had 
been referred, reported on the Dissemination of Diphtheria 
at Funerals. The committee regret that the evidence pre- 
sented has been so slight that they have been unable to 
come to as positive conclusion as would be desirable. Four 
hundred circulars were sent to as many physicians. There 
were two hundred and thirty-nine replies. *' Of these, one 
hundred and forty-three report a belief in the possible dan- 
ger of contagion at the funeral of those who have died of 



* Annales d'Hygi^ne, tome xxvi., 1866. 

f Boston Medical and Surgical Journal, 1876. 



214 VAGARIES OF SANITARY SCIENCE. 

diphtheria." " Seventeen indicate an opinion that there is 
danger from funerals in the houses of the deceased, but 
none in the churches." None of these one hundred and 
sixty physicians names a single case to support his " behef " 
or " opinion." " Twenty-nine correspondents consider that 
physicians are not justified, in the present state of knowl- 
edge, in prohibiting public funerals." " Eight report in- 
stances where the transmission of the disease from a cadaver 
seems probable." Of these the committee cite the four 
most striking, but in none of them was it possible to con- 
clude that the source of infection was the funeral ; for, in 
each instance, diphtheria was present in the town where the 
funeral occurred. Two doctors recollect cases where an 
apparent spread of the disease followed funerals, but the 
committee say of these physicians, " They are unable, how- 
ever, to give full particulars." The committee say, " An 
examination of the text-books, and of the French, German, 
English, and American journals of the last forty years, has 
given no evidence of the contagion of diphtheria from a 
corpse, or even a hint of the possibility of it," except in the 
British Medical Journal oi February 5, 1876. The partic- 
ulars in this instance, however, are taken from a local news- 
paper ; and " the committee cannot consider the testimony 
as very valuable." The committee conclude, from the an- 
swers received, that the ** opinion" is tolerably current among 
the profession that there may be possible danger from public 
funerals, but that the evidence is insufficient to establish 
that there is any danger of contagion from a body dead 
from diphtheria. It is not unfair to conclude that the re- 
maining two hundred and three physicians, who make no 
reply to the circular, had no facts to communicate which 
could bear on the subject, or they would certainly have fur- 
nished them. This report would indicate that the danger 
from public funerals of the dead with diphtheria is so slight 
as not to be worth considering. 



THE MEAT, 21$ 

CHAPTER X. 
The Meat. 

The rising orb of Sanitary Science had poured its beams 
through the atmosphere ; its light had been diffused through 
the water, and dispersed over the soil ; it had pierced the 
gloom of the sewers, illuminated the graveyards, and kin- 
dled the funereal torch of public burials ; but as yet had 
failed to shed its benignant rays on what we should eat. 
Since the beginning of time, the appetites of the various 
races and tribes of mankind had stimulated them to extort 
a pitiless tribute from almost the entire vegetable and animal 
world for their subsistence. Instinct and experience had 
taught them that everything which pleased the taste and 
could be digested and assimilated to the human body was 
good for food. 

There were tribes even that ate the crude soil and found 
nutriment therein. The aborigines of South America and 
New Caledonia appeased their hunger with a fat, ferruginous 
clay and a friable earth. The native of the polar regions 
revelled in the blubbery fat of the walrus and whale. Roots, 
fruit, and fish, with an occasional roast of the enemies or 
friends of their own species, nourished the savages of the 
tropics. Semi-civilized and civilized people had discovered 
and contrived an endless variety of gastronomical pleasures. 
The Hindoo was content with his rice ; to pacify his craving 
for food, the gentle and meditative Brahmin shuddered at 
the thought of taking the life of even the most insignificant 
of his fellow-mortals, which, he religiously believed, partook 
with him of a common origin, and were to share with him 
a common destiny. 



^i6 VAGARIES OF SANITARY SCIENCE. 

" Kill not — for Pity's sake — and lest ye slay 
The meanest thing upon its upward way." 

The timid Chinese shrank from the destruction of life ; yet 
he did not hesitate to eat the flesh of beasts which had been 
slaughtered by others. The nomadic Tartar on the steppes 
of Asia fed on the diseased sheep and oxen of his own 
flocks and herds. Though he gave to the stranger and sold 
to the alien the flesh of animals dead of disease, the lofty 
and disdainful Jew would himself eat none that had not been 
struck down in the flush of health and animal enjoyment. 
And when Israel's people were led captive by the armies of 
Babylon, they became the strictest vegetarians rather than 
defile themselves with the king's meat. " Give us pulse to 
eat and water to drink," they said ; " prove us for ten days." 
And at the end of ten days they were fairer and fatter in 
flesh than those who had eaten the king's meat. And when 
brought before the monarch, it is recorded of this stubborn 
race, ever triumphant in moral and intellectual contests, 
that " in all matters of wisdom and understanding that the 
king inquired of them, he found them ten times better than 
all the magicians and astrologers that were in all his realm." 
That man should kill and eat the domestic animals about 
him which have been his companions and friends, and which 
have requited his caresses and love, has deeply affected many 
a pitying heart. Burns, in his " unco mournfu' tale" of poor 
Mailies's lament, says, — 

" Oh ! bid him save their harmless lives 
Frae dogs and tods and butchers' knives." 

And Goldsmith says, — 

" No flocks that range the valley free 
To slaughter I condemn ; 
Taught by that power that pities me, 
I learn to pity them." 



THE MEAT, 21/ 

Shelley exploded in a passionate protest against destroying 
animals for food; and counselled those who persisted in 
eating flesh to do like the carnivora, who seize their victims, 
tear and devour them while the flesh is still fluttering with 
life. (Note to " Queen Mab.") 

" No longer now 
He slays the lamb that looks him in the face 
And horribly devours his mangled flesh." 

Though these were the sentiments of three of the most 
tender and contemplative cranks of their day and genera- 
tion, they have doubtless been shared by many gentle souls 
who never gave utterance to their thoughts. Against the 
practice of slaying our domestic animals for food is a 
gentle protest in "Jane Eyre," and a hidden rebuke in 
Manzoni. 

That man can exist and enjoy robust health without ani- 
mal food, that man can live by bread alone, is proved by 
individual examples, as well as by many nations which are 
so scantily supplied with flesh that it may be said not to 
enter into their diet. The thirty-six millions of Japanese 
are " essentially vegetarians." * They are restrained from 
eating flesh by poverty and by religious prejudice. There 
are in Japan only two head of cattle to each one hundred 
inhabitants, while in the United States there are seventy- 
three head for the same number of people. Fully one-half 
of the cattle slain in Japan are consumed by the foreigners. 
One-half of the Japanese eat fish every day, one-quarter 
two or three times a week, the remainder once or twice a 
month. The food of the masses is more than ninety per 
cent, vegetable. Nourished by this food, Mr. Van Buren 
says, they show endurance of body, power of intellect, and 
cheerfulness of disposition. 

* Van Buren, Consular Report, 1881 : Food of Japanese. 
K 19 



2l8 VAGARIES OF SANITARY SCIENCE. 

The whole history of man, however, and the close but 
melancholy resemblance in the anatomy of his digestive 
organs with that of the swine, show that, like the latter, he is 
omnivorous ; that since the Creation both have tasted and 
enjoyed every fruit and every animated thing, and every con- 
ceivable combination of the same which have been placed 
before them ; that their instincts and experience have never 
failed to point out what is good, and, except the sanitarians, 
nobody has doubted that each individual is as capable of 
selecting what he requires to eat as any board that may be 
constituted by law. 

In some countries, the cat destined for alimentation is not 
hid under the guise of a rabbit, but is flaunted in the stalls 
side by side with the dog ; neither dog nor cat is wanted to 
kill the rats, for the disposition of these rodents is a special 
and important industry. The luscious toad is roasted and 
made into a hash ; spiders are a comestible recherche ; so 
are maggots and caterpillars ; the silk- and earth-worms are 
held in high repute ; and birds'-nests and an ^g^ ready to 
hatch are the choicest of foods. Maggoty and putrid cheese 
is greatly esteemed in Germany and Italy ; its motive power 
is often so great that a glass cover is used to prevent its 
escape altogether. 

But the reign of Sanitary Terror would not have been 
complete if it had not assumed in some way the control of 
our supplies of food. As early as 1857 * it was discovered 
that " enormous quantities of diseased and half-putrid meat" 
are on sale in London, and " the soup or gravy" is described 
as " an extract of pathological products of pleuro-pneumonia 
and typhoid fever." Mr. Gamgee f says that people both in 
England and in Scotland are consuming enormous quantities 
of diseased meat. Much that he saw at Newgate Market 

* London Lancet, vol. i. 

f Letter to Sir George Gray, 1857. 



THE MEAT. 219 

was unfit for food ; yet it was being sold, scattering " the 
seeds of disease and possibly the stroke of death." Mr. 
Gamgee's periods are startling ; but he does not offer a single 
instance of any disease having arisen in England or Scotland 
from eating these " enormous quantities" of diseased meat. In 
1863 the flesh of cattle dead with malignant pustule is com- 
mon in the market, and at all times the flesh of splenic-fever 
animals is for sale. No investigation was undertaken to show 
that this meat was harmful, no charge was brought that any 
person had ever been made sick through eating it ; but a 
great outcry was raised that if such meat got into the sys- 
tem * it would " cause either low fever or nausea and vom- 
iting." In 1876 it was declared that ** the fattened beasts 
which it is the practice to provide about Christmas" were 
unhealthy. Laws were passed against the sale of diseased 
meat, inspectors were appointed, and prosecutions followed 
without number. Health-officers condemned meat which 
people were desirous to consume ; the dealers resented the 
interference, and trials followed. Some of them were inter- 
esting, not to say ridiculous. On one occasion f the health- 
officer testified that the meat he had condemned would cause 
" various diseases." Dr. Stewart, pathologist of the infirm- 
ary, and Dr. Wood declared under oath that this meat was 
entirely wholesome ; that under the microscope it showed as 
well as any other meat. Professor Dick testified that he 
would eat it ; when asked if he would give it to his friends, 
he replied, " Yes ; and they would lick their lips after it." 
At another trial the evidence was plentiful that the con- 
demned meat was " splendid." Later still % we learn that 
large numbers of cows in the last stages of tuberculosis 
are sold for food; and in 1889 great numbers of cows are 



* London Lancet y 1862. 
f Ibid., vol. ii., 1864. 
% Ibid., vol. ii., 1885. 



220 VAGARIES OF SANITARY SCIENCE. 

afflicted with phthisis ; yet as long as they can walk their 
milk is consumed. 

Most astonishing of all is, that no case of illness, during 
these forty years since the outcry against this meat, was ever 
proved to have arisen from its use. 

But the public mind was in such a ferment about the pub- 
lic health that in nearly every prosecution the defendant was 
convicted. Surgeon T. H. Simcocks * says, " From a phys- 
iological and theoretic stand-point of view, all meat from 
animals killed when in a febrile state is unwholesome ; but 
having regard to the facts and experience of the last thirty- 
five years, I believe there is little or no evidence whatever 
to show that the flesh of pleuro-pneumonically affected 
animals has ever caused disease or even the most transient 
illness." He had eaten such meat himself; had found it 
excellent, and he called on the gentlemen who opposed its 
sale to state if they had ever known it " to produce any, even 
the slightest, ill effects in persons who have eaten it." Dr. 
Simcocks said, "The point at issue is not whether such 
meat is sold in England, but whether it is, or is not, fit for 
human food." This brought a rejoinder from one of the ter- 
rorists, who said it was reported that such meat had caused 
malignant anthrax in Africa ; and that since it had been sold 
in Scotland it was said that boils were more common. This 
hearsay evidence of what happened in Africa and Scotland 
was the only testimony to show that the enormous quantities 
eaten in London caused disease. Dr. Rubridgef says his 
colonial experience was, that the natives of South Africa eat 
the flesh of animals dead of disease, even those which die 
of malignant pustule. When pleuro-pneumonia was intro- 
duced into the colony, the " natives universally ate the dis- 
eased cattle, even those which died, and I never heard of any 



* London Lancet, vol. ii., 1877. 
f Ibid vol. ii., 1864. 



THE MEAT, 221 

evil result from it." Tardieu * says it can be affirmed that 
there is not a single proved fact {pas un seul fait avere) that 
the alimentary usage of flesh from animals dead with con- 
tagious disease has communicated sickness. 

The fright about diseased meat was one of the first that 
was brought forth in our own country. The Massachusetts 
Board of Health took it up quite early, and in searching for 
evidence found that " tons and tons" of decayed and putrid 
meat were made into sausages and eaten ; and that hitherto 
no case of disease could be traced to this cause. The board 
quotes the special investigation of the Privy Council by Dr. 
Thorne, who visited thirteen towns in England, some of 
which had large populations. No instance could be found 
of disease having occurred from the use of flesh of animals 
sick with foot-and-mouth disease ; and it was affirmed that 
some of the primest meat used in London was taken from 
beasts suffering from acute inflammations. The Massa- 
chusetts report for 1875 says the people of the Faroe Islands 
habitually eat meat in a high state of putrefaction ; that 
sausage is the grand receptacle of vile meat, but that through 
cooking it may be relied on not to cause disease ; that putrid 
meat was largely eaten in Paris during the siege of 187 1 
without ill effects ; that in many of our large towns great 
quantities of meat from cattle sick with Texas cattle-disease 
are eaten without harm ; that in Illinois was a fatal epidemic 
of splenic fever, and that there was not a single case of dis- 
ease from eating the milk and flesh of these cattle. The 
board concludes, " We think that the fact that meat has been 
taken from diseased cattle should be of itself enough to 
condemn it; and no meat should be allowed to leave the 
shambles in any part of this State without thorough inspec- 
tion and permission of sale being given by a properly-quali- 
fied person." Unaccountable conclusion ! The board has 

* Dictionnaire d'Hygi^ne, article ** Contagion." 
19* 



222 VAGARIES OF SANITARY SCIENCE. 

not adduced a single case of disease produced by such meat ; 
on the contrary, it has presented a vast amount of testimony 
to prove that it is harmless. 

Long before the reign of Sanitary Terror, or even before 
the dawn of Sanitary Science, the question as to the noxious 
character of diseased and putrid meat had been studied, not 
only by individuals, but by government commissions. Dr. 
Chisholm, in the Edinburgh Medical Review, vol. vi., after 
referring to Spallanzani's experiments on animals with putrid 
meat, and to the testimony of numerous travellers who affirm 
that whole tribes and races consume, without hesitation, 
putrid flesh and that of animals dead of disease, concludes 
that if, by selection, accident, or necessity, putrid or diseased 
flesh becomes the food of men, it is harmless. 

One of the earliest reports to the French government on 
this subject was made by M. Huzard on the " Phthisis of 
Milch-Cows in Paris in 1814." Large numbers were brought 
here by forced marches and huddled in low, unventilated 
stalls ; they developed inflammation of the lungs (epizootic) ; 
many perished ; the greater part, however, were consumed 
by the people, and no evil results followed. 

In 1 8 14, when the allies came to Paris, they brought with 
them thousands of cattle which they had seized en route ; 
these soon became afflicted with contagious dysentery. 
None of those which died were lost ; they were eaten by the 
alHed troops, who had no other meat ; this was consumed 
also in the hospitals. No inconvenience followed its use. 
In Annales d'Hygiene, vol. x., 1833, is a report made by M. 
Huzard {fils) to the Conseil de Sahibrite of Paris on the sale 
of the meat of animals dead of disease ; he concludes that 
charbon alone can give unwholesomeness to meat ; that there 
are many examples to prove that people have eaten the flesh 
of beasts dead of charbon without any accident following ; 
but that this disease has been communicated to butchers 
who have killed the animals. 



THE MEAT, 223 

In Annales d'Hygiene, vol. xxii., 1839, ^^ ^ report of seven 
scientists, to the French government, on the epizootic which 
prevailed among cattle in Paris at that time. After minutely 
describing the symptoms of the disease, the commission 
declares that to the eye, nose, and taste (a la vue, a I' odor at ^ 
au gout) the milk had all the signs of the best milk ; that it 
had been used partly in the country, but mostly in Paris. 
When it was given to calves, some were attacked with the 
disease, others were not ; when given to pigs, dogs, and 
poultry, no accident happened. That the milk was harm- 
less to man was proved by the fact that long before the in- 
vestigation began, and when the disease was at its height, it 
had been largely used without any derangement to the pub- 
He health. As to the flesh, the commission says that the 
facts are more pronounced. Large quantities had been con- 
sumed before the disease was generally recognized, and 
since then the consumption had continued, and no case of 
disease could be found to have occurred from its use. 

In a report presented to the French government * is a 
reply to the question. What maladies of cattle render their 
flesh unwholesome ? The commission reports that though 
charbon, when innoculated into butchers, veterinary surgeons, 
and physicians, has caused death, yet it is equally certain 
that men in great numbers have eaten the flesh of animals 
dead of that disease, and that the best-informed veterinary 
surgeons agree that such flesh is harmless. The reporter 
says we ought to declare loudly [nous devons le dire tres 
haut) that it is the fear that a meat may be unhealthy, and 
not the certitude, that causes us to reject it, and that it is 
the disgust that this diseased and putrid meat inspires, and 
not its unwholesomeness, which has caused it to be pro- 
scribed by municipal administrations. 

In 185 1, M. Delafond, veterinary surgeon, issued a pamph- 



* Annales d'Hygiene, 1848. 



.224 VAGARIES OF SANITARY SCIENCE. 

let entitled " De I'msalubrite et de I'innocuite des viandes, 
etc." He says that the butchers' monopoly in Paris made 
a great clamor that the public health was in danger from 
diseased meat, because at one of the markets flesh was sold 
at auction. M. Delafond keenly intimates that nobody 
knows as well as these same butchers, who are suddenly so 
solicitous for the public health, how much diseased meat is 
sold in Paris. A mass of imposing facts, he says, have 
been brought for the last one hundred and fifty years to 
prove that the consumption of flesh from animals dead of 
contagious diseases is harmless: by Ramazzini in 171 1, 
Carcain in 1714, Camper in 1745, Dufau in 1775, Beaumont 
in 1796, Huzard and Deplas in 1795, Huzard and Merat in 
1814, Groguier and Coze in 1814 and 1815. M. Delafond 
had often witnessed the slaughtering and sale of diseased 
animals for food, and he believed it positively demonstrated 
that such meat was harmless. Decroix, V. S.,* says that 
for ten years ending with the siege of Paris, 187 1, he had 
taken every opportunity that presented to eat the flesh of 
horses dead of glanders, typhus, hydrophobia, etc., cooked 
in different modes, — sometimes well done, sometimes rare. 
In spite of the disgust which it excited he never felt the 
slightest illness. A good many people had partaken with 
him of this food, — sometimes knowing its character, at other 
times ignorant of its condition. He even ate raw flesh of 
horses dead of glanders. He concludes that the meat of 
animals dead of any disease is perfectly proper for alimen- 
tation. 

In the reports of the imperial customs of China are re- 
corded many accounts of epidemic diseases of cattle in that 
country. It is almost always stated that the flesh of these 
animals is consumed by natives and foreigners, and gener- 
ally that it is proved to be harmless, and disease from such 

* La France Midicale, l%^l-^2. 



THE MEAT. 225 

cause is never reported. Dr. Scott, of Swatow,* reports a 
grievous epidemic among cattle, destroying as many as 
ninety per cent, of cows and buffaloes in some districts, and 
so virulent that they die in a few hours after their seizure. 
" The Chinese ate the flesh of the diseased animals with im- 
punity," and ascribed the good health of the people that 
season to the fact that all of the disease was among the 
cattle. At Chefoo, Dr. Carmichael says, the flesh of animals 
that died of cattle-plague was eaten, and was followed by 
no ill effects. At Wauchow the meat sold was for the most 
part from animals dead of disease. Dr. Somerville, of 
Foochow, says that his inquiries were searching as to the 
effects of eating the flesh of diseased animals. " It "might 
be eaten by any one audacious enough to do it." " It was a 
case of pure choice and audacity." He " excludes meat in- 
fested by parasites." M. Zundel, veterinaire superieur of 
Alsace-Loraine, in a communication to the Society of 
Sciences and Agriculture of Basse- Alsace,t says that though 
the transmissibility of tubercle from man to certain domestic 
animals by the stomach has been shown by some, but de- 
nied by others equally competent, there is no reason to 
conclude that this action is reciprocal in man, and that there 
is no proof that the flesh of tuberculous animals has ever 
caused human phthisis, though the subject has been under 
close observation by medical men for fifteen years. In the 
same volume of this review is a communication from Berlin 
by Dr. Villaret, who shows that by far the greater number 
of the cattle and swine adjudged to have phthisis in that city 
are consumed for food, and that each inhabitant of Berlin 
has a chance of eating more than two pounds of tubercu- 
lous meat annually. In the same volume Dr. Vallin says 
Paris is 2, Minotaur e ; it devours everything which can be 
eaten : " tout ce qui peut se manger il le devore T that from 

* 1880. t Revtie (THyphiey 1S83. 

P 



226 VAGARIES OF SANITARY SCIENCE. 

one hundred and fifty leagues about the city meat is brought 
in that is undoubtedly diseased ; that the inspection is an 
illusion; that if this meat were condemned the inspector 
would be stoned by the mob ; and that the question whether 
such meat is unwholesome is yet undecided. The only 
case that the author can find of disease being caused by 
eating the flesh of sick animals is reported by Dr. Horsch,* 
who saw a patient, seventy years old, with an enlargement 
of the inguinal glands. He found that his patient had 
eaten meat from an ox that had a swelling near one of its 
ears. The doctor says, " This is a case where I found no 
other cause than that diseased meat." He does not say 
that his patient was the only one who partook of this beef, 
or if he ate the whole ox ! Dr. Horsch also reports that a 
man died of fever after eating some salted flesh of an ox 
which had murrain. He does not say whether in this case 
the patient ate the whole ox. That tubercle can be imparted 
to man by the ingestion of flesh of animals which have had 
this disease is, so far, pure hypothesis. M. Trasbotf de- 
clares that no case of such transmission has yet been brought 
forward, yet the opinion has become a dogma. This 
" opinion," which has become a dogma, is sharply con- 
tested by the most acute French and German observers. 
Flugge X says that raw tuberculous meat may give phthisis 
to man, — he does not say that this is proved, — but when 
cooked it is harmless, and that there is no proof that the 
ptomaines, which are sometimes developed in putrid meat, 
are caused by sick beasts. 

A most important fact is this, that in all or nearly all of 
the cases of poisoning from meats, cheese, or other animal 
foods which have been reported during the last seventy-five 



* Proceedings of the American Public Health Association. 

f Revue ^Hygiene, 1 890. 

\ Grundriss von Hygiene, 1888. 



THE MEAT. 22/ 

years, no investigations have determined the cause ; and in 
almost all it has been proved that the aliments were of 
entirely good quality. In Kloten, canton Zurich, in 1878, 
at a musical fete, a large number of people fell ill after par- 
taking of the banquet. None of the viands were distrusted 
except the flesh of a calf, which, " it was said," had evaded 
inspection. It was not proved that the calf was diseased, 
but it was so presumed ; and as many persons were seized 
who had declined the veal and had eaten only beef, it was 
presumed that all of the meat had been contaminated by using 
the same knife which had sliced the calf! The disease was 
diagnosed gastric catarrh and typhoid fever, which autopsies 
confirmed. One hundred and twenty-one of these cases 
were pronounced by M. Walder to be true typhoid. It 
would seem that either the diagnosis of typhoid fever was 
not correct, or the meat was not at fault ; for the day after the 
fete there was an abrupt explosion of the disease ; the larger 
number of cases developed before the third and fourth day, 
and none later than the ninth, after partaking of the meat. 
There had been no case of typhoid fever at Kloten,* nor in 
the neighboring villages, for a great many years. On this 
occasion the public listened with avidity to all sorts of stories. 
A dog which had gnawed a bone that had been tossed from 
the banquet-table was seized with convulsions, and a croc- 
odile that was in a menagerie in the town had misery in 
the bowels (iiiaux de ventre), after having been fed with some 
of the beef, though the account does not say to whom the 
honor belongs of making the diagnosis. 

It may be that this attack of so many people at Kloten is 
of that large number of mysterious seizures which are unex- 
plained. It is stated that forty or fifty of these cases followed 
by propagation from the original ones. All efTorts to inoc- 
ulate calves or other animals by feeding them with the stools 

* Revue d'' Hygihie, 1879 (Zuber). 



228 VAGARIES OF SANITARY SCIENCE. 

of the sick people failed. Another singular fact is, that 
these examples of what is supposed to be poisoning from 
meat, cheese, and ice cream almost always happen where a 
large number of people are gathered together, as at a fete. 
The true cause of these attacks is not yet explained. 

One hundred and sixty-five pages of the report of the New 
York City Board of Health for 1868 record the appearance, 
course, symptoms, and morbid anatomy of the Texas cattle- 
disease in that city in July, 1868. There was widespread 
alarm, which was increased by a notice from the board that 
there was a sudden rise in mortality in that month from 
diarrhoeal disorders ; and it was bruited about that the meat 
of sick cattle was the cause. It was known that large quan- 
tities of it were eaten ; but if the board made any inquiry to 
discover whether it was connected with the bowel troubles, 
they made no record of the fact. The fact is ignored en- 
tirely in the report, but is recorded elsewhere in the board's 
general report, that the mean temperature for the three 
months ending October 3, 1868, was five degrees higher 
than it was the year before in the same months. The fact 
is ignored also, but recorded elsewhere in the report, that 
the great rise in mortality that year was among children 
under one year. Not a single case of disease from the use 
of the meat is offered ; and although it was known precisely 
where the great increase in mortality lay, — namely, in the 
Nineteenth, Twentieth, and Twenty-second Wards, — if it 
bore any relation to the use of the meat and the board knew 
it, they were careful not to mention it. The Registrar of 
Vital Statistics that year says, " The phenomena of rapid 
increase and obstinate fatality of diarrhoeal disorders" were 
more marked in the Twentieth and Twenty-second Wards, 
and later in the Nineteenth, "than in the infamously ill- 
housed and crowded Fourth and Sixth Wards." The quan- 
tity of fatal disease in the Twenty-second Ward is " some- 
thing enormous, though the social and domestic condition 



THE MEAT. 229 

of the people and the natural advantages of locality are far 
superior to those of the Fourth and Sixth Wards." Was 
the diseased beef sold and consumed in the well-to-do 
Nineteenth, Twentieth, and Twenty-second Wards ? The 
board does not say whether any inquiry was made to ascer- 
tain the fact. In an authoritative way the reporter, who 
presumably speaks for the board, says, " It is idle to talk 
of such meats being safe and wholesome for food." We 
respectfully submit whether it is not " idle to talk" about it 
at all until positive information is obtained. The board 
made no effort to still the great alarm of the people ; on the 
contrary, their words and actions all tended to exaggerate it ; 
and this report is not unfrequently quoted by sanitary writers 
to prove the noxious character of diseased meat. 

Parkes,* after summing up the testimony on diseased 
meat, directs the British army surgeon, in time of war, if 
healthy beasts are not attainable, to " allow the issue of all 
animals ill with inflammatory and contagious diseases, with 
the exception of small-pox, and perhaps splenic apoplexy in 
sheep." But he says, if necessity compels the use of animals 
sick with small-pox, great care in cooking should be used. 
The untutored man in Sanitary Science is here again puzzled. 
Why a food which is suitable and healthful for a soldier 
in time of war, while he is defending his own or invading 
another's country — just at the period when it is most impor- 
tant to preserve his vigor — should, as soon as peace is de- 
clared, become so perilous to the public health that those 
who buy and sell it are to be fined and imprisoned, must 
forever remain one of the impenetrable mysteries of Sanitary 
Science. 

Notwithstanding that the sanitarians had no evidence to 
implicate in the causation of disease any of the foods which 
they had proscribed, the public mind, which had been so 



* Hygiene, 18S7. 
20 



230 VAGARIES OF SANITARY SCIENCE. 

susceptible to fright about the air, the water, the soil, and 
the sewers, was now in a condition to be panic-stricken about 
diseased and putrid meat. 

That the flesh of animals begins to resolve itself, under 
the influence of heat and moisture, into its original elements 
as soon as life is extinct is a self evident proposition. The 
sanitarians now began to excite the fears of the people that 
the public health was in danger, unless they were endowed 
with power to determine through their inspectors the precise 
moment when this decomposition was a source of peril. 
They professed to see great danger in the consumption of 
immature veal ; and in many instances procured the passage 
of ordinances forbidding its sale, if slaughtered under four 
weeks old. What diseases such food would cause they 
never deigned to tell us. It is, in fact, as innocent as a 
new-laid ^gg or a raw oyster. It was known that in many 
countries foetal veal was largely eaten ; in some it was es- 
teemed as a delicacy. Why it should be wholesome and 
desirable in Italy and the Argentine Republic, and impair 
the public health in England and the United States, we were 
never informed. Regarding roast pig, we have the uncon- 
tradicted testimony of Charles Lamb, — " It must be under a 
moon old ; guiltless as yet of the sty." The fat, — " Oh ! call 
it not fat, but an indefinable sweetness growing up to it, — the 
tender blossoming of fat." " The lean, no lean, but a kind 
of animal manna, or rather fat and lean (if it must be so), so 
blended and running into each other that both together make 
but one ambrosial result." 

The sanitarians never explained why feathered game, and 
venison and mutton, in various degrees of offensive putre- 
faction, were to be eaten with impunity and even with gusto, 
and beef and poultry in the same condition should be shunned 
as dangerous. Not one of them raised his voice against arti- 
ficially-diseased geese-livers, which the gourmand so highly 
prizes under the name oi pate defoiegras, and which lately. 



THE MILK, 231 

according to M. Mouille, have been found to be a pure cul- 
ture of tubercle. But they succeeded in getting their in- 
spectors appointed, and for a while the public tranquillity 
was restored. 



CHAPTER XI. 
The Milk. 



After the installation of the meat inspectors a new sense 
of security pervaded the community, and the outlook for the 
public health grew brighter. The air, the water, the soil, the 
public improvements, the cemeteries, and the meat were under 
careful surveillance. 

Once in a while we were somewhat dejected, and our faith 
in Sanitary Science wavered a little, as we surveyed the new 
dignitaries and reflected on their antecedents. They were 
chiefly either party mendicants or the poor relations of more 
ambitious politicians, — men who had never before in life been 
noted for anything but a general inefficiency. Not one of 
them made any pretence of possessing scientific attainments. 
We tried to think that maybe by some process of laying on 
of hands by the apostles of the new doctrine, a kind of sani- 
tary grace or unction had been imparted to them ; but in 
spite of these reflections we had to confess to ourselves that 
if, before their appointment, we had needed any counsel 
regarding the supply of our table, we would not have sought 
for it from the new inspectors. 

But the sanitarians, in their journals and on the platform 
in convention assembled, cheered us with the news that Sani- 
tary Science was making " gigantic strides ;" that yet a little 
while and the enemies of the public health would be subdued, 
and the mockers at the founders of the new truths would be 
silenced. All at once, like a thunderbolt out of a clear sky, 



232 VAGARIES OF SANITARY SCIENCE, 

an alarm was sounded from a most unexpected q\iarter. 
There was poison in the milk ! 

If there was anything on the earth's surface which had 
hitherto escaped the charge of original or acquired sin, it 
was this bland and innocent fluid. Ever since we had re- 
course to the maternal bosom, our respect for its purity had 
been maintained. The sanitarians now commenced to smut 
and defame it as if it were a vile drab. It was the messenger 
of typhoid fever, diphtheria, and scarlatina ; and from thirty to 
fifty per cent, of all milch cows poured the tubercular bacilli 
fresh from their udders. The blow was all the more stun- 
ning, because for twenty-five years there had been a singular 
concord of opinion among practising physicians that milk 
v/as a most appropriate diet during the progress, and espe- 
cially in the convalescence, of the first three diseases ; while 
in consumption it was specially adapted, and unless some 
idiocrasy forbade it, it had been unconditionally recom- 
mended to be used as soon as possible after it was received 
from the cow. But now we were told that the animals whose 
milk had been esteemed the highest for consumptives, on 
account of its richness in cream., were precisely those that 
furnished the tubercular bacilli in the greatest abundance. 

For a quarter of a century the doctors had been drenching 
us with these bacilli, and had been adding fuel to the flames 
which were destroying us, and at the same time had been 
reporting improvement of their patients, and an occasional 
cure, under the use of milk. There had been this consoling 
thought about the meat : it was consumed by adolescents 
and adults, who possessed a certain amount of resisting 
power to morbid influences ; but the new danger menaced 
us at a point which we were least prepared to defend. It 
shook the foundations of society, and threatened the anni- 
hilation of the race by a wholesale destruction of infantile 
life. Our very hopes of posterity were now to be blasted by 
the Herods of the milk-can. 



THE MILK. 233 

The dispensers of this fluid, the sanitarians said, not only- 
sold diseased milk, but they were careless in the delivery of 
that which was sound. Milk was quick to undergo changes, 
and these variations in its character were fruitful sources of 
disease. It was of no use for some to mildly protest that 
for six thousand years men, women, and children had taken 
milk in all sorts of conditions ; fresh from the mother cow ; 
acid from commencing decomposition ; still further resolved, 
it had been prized under the appetizing name of bonny clab- 
ber ; children had begged for buttermilk ; after it had parted 
with its caseine and fat, sick, well, and convalescents had 
swallowed the whey with delight. 

The sanitarians said that all this violated " the settled 
principles of Sanitary Science ;" that milk passing through 
these changes was filth, and would cause filth-diseases ; and 
that the only way to protect the public, save the infants, and 
restore the invalids, was to have a proper number of milk- 
inspectors appointed. As soon as these were invested in 
office, the public tranquillity was, in a measure, again re- 
stored. 

Those who knew that any examination of milk, to be 
worth anything, called for expert knowledge in the oper- 
ator and a famiharity with the technicalities of organic 
chemistry which required years to obtain, saw through the 
hmpid humbug ; to the mass of the people, in the excite- 
ment, it was enough to be told that somebody was inspecting 
the milk. 

Twenty years after the era of sanitary reform, typhoid fever 
was continually breaking out in England, just as it had done 
previously to 1850. Some new creation was necessary to 
continue the excitement and extend the panic. It often hap- 
pened in that country, as elsewhere all over the world, that 
a typhoid fever epidemic was circumscribed in its extent by 
a few acres ; that sometimes it would be confined to one side 
of a single street, or to a certain number of houses in a single 

20* 



234 VAGARIES OF SANITARY SCIENCE. 

block. The London Lancef^ reports a typhoid epidemic 
limited to an area of forty square rods, where were twenty- 
four cases. Another at Greenock was confined to a spot 
of five hundred yards, in the most airy, best-drained, and 
reputedly healthy portion of the town. One epidemic in 
Massachusetts was confined to a space fifteen rods square. 
It happened sometimes that these circumscribed places re- 
ceived the same or nearly the same milk-supply. 

In none of the so-called epidemics from the use of milk 
which the author has studied is there any truly scientific 
evidence to support the belief that this was at fault. In all 
of them there is a varying proportion of cases of the disease 
which are admitted to have some other — some unknown — 
origin. That the admitted unknown origin was competent 
also to cause the other cases is denied by none. It is ten 
years since the typhoid bacillus has been discovered ; the 
sanitarians avow that without this germ typhoid fever can- 
not occur. In no case of so-called milk epidemics of typhoid 
fever has the bacillus been found in the milk. A singular 
fact is that almost all of these epidemics have occurred in 
England, and, it might be said, close to the ear of the Lon- 
don Lancet. More than seventy had been reported as early 
as 1880. As soon as it appeared that this cause of disease 
was to become the mode, and that stories of milk-poisoning 
would be acceptable to that journal, the compliant English 
physicians poured in accounts of epidemics caused by milk, 
thicker than were the tales of Popish plots two hundred 
years before. 

At first it was necessary that a case of typhoid fever 
should have occurred at some time, near or remote, some- 
where in the vicinity of the suspected dairy ; later, a case of 
rheumatism answered the purpose ; and in one extensive 
epidemic f it was proved by the testimony of two surgeons 

* Vol. i., 1874. f Chemical News, vol. xxxii. 



THE MILK. 235 

that th€ person who was accused of spreading typhoid fever 
through milk actually had heart-disease. Later still, no dis- 
ease at all among people of the dairy was required to make 
out an epidemic from milk ; the affidavit of somebody that 
a cow had been dallying with a pool of dirty water or had 
drunk from a well which was located near a stable or privy 
was enough. 

It was asserted that typhoid fever had been caused by the 
milk of a sick cow. One epidemic was ascribed to the milk 
of a cow suffering from metritis. In another, a dairyman 
admitted that three of his cows were affected with a " stiff- 
ness" a short time before typhoid fever broke out in his family. 
It sometimes happened that the disease had existed days and 
weeks on the milk route before it broke out at the dairy ; but 
these passed for epidemics from the use of milk, just as if the 
occurrence of the fever had been reversed. One epidemic is 
reported as arising from milk which had been contaminated 
by a pool of stagnant water from which the cows had drunk. 
One surgeon writes that he is convinced that the milk of 
cows which have drunk dirty water can produce typhoid 
fever ; in India he had seen them licking manure, which he 
thought made the milk impure, and caused typhoid fever 
among the soldiers ! This was a little too much for even 
the London Lancet ; it was not quite ready to accept the 
stagnant-water theory, " since it would be subversive of all 
that is known and admitted concerning the etiology of the 
disease." One epidemic of typhoid fever caused by milk is 
reported at Ascot,* which lasted four and a half years. No 
epidemic had been known in Ascot for forty years ; only 
now and then a case had occurred there during these forty 
years. 

Dr. Beveridge f reports an epidemic caused by milk from 
the Oldham Reformatory. An official investigation showed 

* Sanitary Recot'd, 1 879. f Sanitary Journal, Glasgow. 



236 VAGARIES OF SANITARY SCIENCE. 

that a cistern at the dairy had a loose cover, and it was de- 
cided that the water could absorb exhalations from the barn, 
and corrupt the milk through washing the cans with it. 
Analyses of the water were made by two different chemists ; 
one pronounced it pure, the other disclosed albuminoid 
ammonia. The investigator chose the latter analysis, and so 
convicted the milk of causing the disease. There was no 
sickness of any kind at the Reformatory; it is expressly 
stated that all of the boys were well, although they partook 
freely of the milk. This is explained by the fact that the 
boys did not use the milk "exclusively," and that "what the 
boys got was evening milk, skimmed ; and various circum- 
stances show that the evening milk, especially if skimmed, 
was the safest thing about the place to use." Nothing is 
said whether any one at the dairy drank of the water which 
infected the cans, which infected the milk, which infected the 
people. 

In 1883 * there was an outbreak of typhoid fever from 
the use of milk at St. Pancras ; but there was a remarkable 
immunity from disease at and near the farms that supplied 
the milk, and now it is hinted that maybe the cows had this 
fever in a mild form, although they appeared in good health. 
The editor of the Lancet says, " It is a debated question 
whether the milk is infected on account of the cows being 
affected with a mild attack of the fever," and being, " so to 
speak, the wet-nurses that carry the infection of enteric 
fever." " Exact observations," he says, are much needed 
to elucidate this subject. 

Dr. Louis Parkes f relates an epidemic at St. Albans 
among the customers of a particular dairy. There was 
complete absence of any evidence that the milk had become 
infected. Dr. Parkes says that an outbreak of scarlatina 

* London Lancet, vol. ii. 

f Transactions of the Sanitary Institute of Great Britain, 1879. 



THE MILK, 237 

was traced to milk from a farm at Farnham. Mr. Power 
reported that it was impossible that the milk could be in- 
fected " in any of the commonly-believed ways." However, 
the investigation was not allowed to rest there, and the 
astute inquirer, who showed great sanitary discernment, was 
rewarded by the discovery that the cow had " here and 
there lost a portion of her coat, and that her buttocks and 
posterior udder were soiled and stained by excrementitious 
matter." This revelation satisfied the investigator that the 
milk caused the scarlet fever. 

In another scarlatina epidemic which was caused by the 
milk, some vesicles were found on the teats and udders of 
the cows. The animals showed no other signs of illness ; 
they took their food, and gave their usual supply of milk, 
and their bodily temperature was normal. In fact, these 
vesicles would very likely affect the health of the cow much 
as a pimple on a man's face would affect his general health. 
The English investigators, however, seem to have been per- 
fectly contented with such explanations of these epidemics. 
Dr. Parkes says that in epidemics of diphtheria caused by 
milk, " It has not been possible in a large percentage of the 
cases to trace the source from which the milk derived its 
infective quality." One outbreak of this disease at Hendon 
was attributed to a " ropiness" in the milk due to garget in 
the cows, although no evidence was obtained of this or any 
other disease being prevalent at the farm among the cows 
prior to the outbreak." It may be thought that Dr. Parkes 
was indulging in a little pleasantry in the presentation of 
this paper on " milk and disease." However, his hearers 
do not seem to have perceived it, for it is related that " a 
vote of thanks was accorded" to him for his discourse. 

Diphtheria at Camberly is reported * as being caused by 
milk. The sanitary condition of the dairy which furnished 

* Sanitary Record, 1887. 



238 VAGARIES OF SANITARY SCIENCE. 

it is exceptionally good ; no disease is there, either among 
the cows or the people. The undaunted sanitarian who 
investigated this epidemic pushed his inquiries still further 
and found that " two of the animals showed some signs of 
chaps on their teats," and this accounts for the diphtheria 
at Camberly. 

The Lancet oi August 13, 1892, tells us of outbreaks of 
scarlet fever in London which were " traced to the distri- 
bution of an infected milk-supply," but " careful inquiry failed 
to show" that there had been any disease at any of the 
dairies. The investigators did not cease their labors until 
they had found a cow which was said " to have a cough" 
and to be " off her feed." This cow and four others had 
some abrasions on their udders. The six days that the cow 
suffered with the cold were " the six days of maximum in- 
fective power of the milk," and the very day on which treat- 
ment of the cow was commenced ** the infective property 
became less marked." In spite of the solemnity of the 
editor of the Lancet, who records and comments on these 
remarkable facts, we are sure he is jesting, and his imper- 
turbable gravity heightens our amusement as we listen to 
him. 

In 1889,* Dr. Anderson reports at Dundee an epidemic 
of typhoid fever occurring on a particular milk-route. 
" The most searching inquiries failed to find any trace of 
the disease among those handling the milk, or in their 
households." On one of the cows, however, which was in 
perfect health, an eruption like a ringworm was found on 
one of the teats. Dr. Smith had the temerity — no one else 
shared his rashness — to say that he saw no connection be- 
tween this eruption and the epidemic of typhoid fever at 
Dundee. 

The excitement reached such a pitch in England that the 

* Medical Record, September 7* 



THE MILK. 239 

most stringent regulations were made ; inspectors were ap- 
pointed, and, of course, prosecutions were commenced. For 
the most part the dairymen were glad to flee the wrath of 
the implacable sanitarians, but here and there was one deter- 
mined not to succumb without a struggle. He was always 
worsted. There was one who attempted to defend himself 
on the ground that there was no history of any disease at 
or near his dairy, and he refused to go out of business. 
His testimony was unshaken, but the Lancet X.o\di him sharply 
that " those dairymen were likely to fare best who swim 
with the stream, instead of attempting to stem it." The 
dairyman seems to have taken the hint, for we hear no more 
of him afterwards. 

It hardly ever happened that there was any accusation of 
a direct infection of the milk, but a favorite method of ac- 
counting for the epidemics was that the stools of typhoid 
patients, thrown on the ground or into a privy, retained 
their infecting power for months and even years, and that 
the germs percolated through the ground and infected water- 
supplies which were used to cleanse the milk utensils. The 
germs of typhoid fever were said to hold their vitality in 
the ground * for an indefinite period ; " for several years at 
least." Dr. Frankland reported an instance in Switzer- 
land where the typhoid poison filtered through earth a mile 
away. 

There was something very bewitching to the sanitary 
fancy in this roundabout way of accounting for an epidemic 
of typhoid fever from milk. It looked to the reformers like 
science, and they seemed to imagine that they were unrav- 
elling some plot against the public health. It must be re- 
membered that no one claimed to have any proof that water 
sources were thus polluted. The sanitary Gullivers never 
pretended that they had made any investigations to show 

* Connecticut Board of Health Report, 1SS2. 



240 VAGARIES OF SANITARY SCIENCE. 

the possibility of so defiling water-supplies. They relied on 
their imaginations and the credulity of the public. By the 
h'ght of later experience on a great many sewage-farms, 
and the still more positive evidence of experiments with 
the typhoid bacillus in ordinary earth and in the presence 
of putridity, every one of these epidemics which have been 
ascribed to water polluted in this way must be thrown out 
altogether. 

Towards 1883 the English mind seems to have been sur- 
feited with these tales, for Dr. Saunders * warns people 
against " being too ready to credit milk with more than its 
due ;" and he shares " with many others the opinion that in 
a number of cases in which milk-pollution has been asserted 
to have produced disease the proof has by no means been 
clear," but in 1884 the excitement is renewed, and the Lancet 
says one can hardly take up a morning newspaper " without 
discovering that disease and death have been disseminated 
through the milk-can." 

No attempt seems to have been made to transplant epi- 
demics from the use of milk to the continent. That they 
arose nowhere but in England attracted the notice and 
excited the merriment of the French, who described the 
milk pathology of typhoid fever in England,t as ^' Vespece 
d' entrainemenf' which had reigned there for the last few 
years. Jules Arnould % says that the merit of having made 
the sagacious observation of surprising milk en flagrant 
delit de colportage of typhoid fever belongs to Dr. Ed- 
ward Ballard, and that this high treason (haute irahison) 
on the part of the milk was first committed at Islington. 
Arnould says a little calm is now § restored, although there 
is no reason for thinking that any more trust should be put 
in a milk-dealer. He thinks that these milk stories are 

* London Lancet, vol. ii., 1883. 

f Annales d'Hygiene, 1882. 

X Nouveaux Elemens d'Hygiene. § 1881. 



THE MILK. 241 

wanting in precision, and do not show much perspicacite on 
the part of the historian. Dr. Vallin * says that there is 
■not a week which does not bring forth some story of an epi- 
demic caused by milk in England, and that an Enghsh phy- 
sician who would throw any doubt on the reality of such a 
mode of propagation would be considered malaishnent. Dr. 
Vallin says that what justifies our scepticism regarding these 
epidemics is that the English have been content to presumer 
that the milk is infected. He is not aware of a single micro- 
scopic examination. No one there, he says, has even sought 
the " corps du delif in the milk. He adds that a serious 
observer in France would not relate such an epidemic until 
he had at least searched the milk. Bouchardat f says that 
in France, where the use of milk is much more general than 
in England, we rest in complete security respecting its being 
a conveyer of typhoid fever. 

The sanitary Anglomaniacs of this country have made 
some desperate efforts to introduce the milk theory of epi- 
demics here. One of the most brilliant achievements of Sani- 
tary Science in this direction is recorded in the report of the 
Connecticut Board of Health for 1890. Here is related what 
is called an investigation of the rise and progress of an epi- 
demic in Waterbury, Connecticut, in June, 1 890. The investi- 
gators in this example were true to their imitative instincts ; 
they servilely followed as closely as possible the methods, 
and are entitled to the acclamations of the English explorers. 
For the previous five months typhoid fever had prevailed in 
that city, but in June there was a sudden increase of the 
disease. Fifty cases happened in that month, and forty-one 
of them occurred on the route of one milk-dealer, who fur- 
nished six hundred quarts of milk to between twelve hun- 
dred and fifteen hundred people. Three cases broke out 



* Revue d'Hygiine, i8Si 
f Traite d' Hygiene. 
21 



242 VAGARIES OF SANITARY SCIENCE. 

before the loth, eighteen before the 15th, and twenty-seven 
before the 20th of June. The farm-hand, who was the only- 
one accused of infecting the milk, was taken sick on the 
7th and removed to the hospital on the 9th of June. Be- 
fore the 7th he had defecated in the barn-yard, thus says 
the report, " infecting the mass of material there," and por- 
tions of the infected mass being dried were blown as dust 
into the milk-cans, which were placed in a tank in the barn. 
The fact is established that the farm-hand had no diarrhoea 
previous to his removal to the hospital. If it was possible 
for him to thus infect the manure, so that this by the aid of 
sun and wind could corrupt the milk, the latter infection 
could not have happened before the 9th or loth of the 
month. But by the loth three (one occurred on the 8th) of 
the forty-one cases had typhoid fever, by the 15th eighteen, 
and by the 20th twenty-seven of the forty-one cases were 
down with the disease, eleven days after exposure. 

The reporter of this epidemic gives from twelve to twenty 
days as the incubative period of the disease ; but here we 
have twenty-one of the forty-one cases occurring within a 
week, and twenty-seven within eleven days after exposure. 
The experiments of Karlinski * showed that of twenty-one 
cases of typhoid fever that he examined, the typhoid bacillus 
could not be found before the ninth — in the larger number 
it was the eleventh and twelfth — day after the patient was 
seized with the disease. To admit that the milk was the 
cause of these twenty-seven cases, we must reconstruct en- 
tirely the theory of the incubative period of the disease, 
which the reporter of this epidemic recognizes as from 
twelve to twenty days. There were a number of facts which, 
if the Connecticut Board of Health obtained them, they 
were careful not to record. A cluster of twenty-five fami- 
lies living in the " Burnt Hill" district took this milk and 

* Ceiztralblatt, 1 889. 



THE MILK. 243 

no fever followed. Twenty-one people visited the farmer's 
house ; all partook of the milk and none of these had any 
fever. Eleven men worked in the infected barn-yard during 
the month of June ; nine of these drank of the milk and 
none of them took the fever. 

Nevertheless, this tale has gone into sanitary literature as 
a genuine epidemic from the use of milk. Strange to say, in 
this instance, like all others of the sort, the bacillus was not 
searched for either in the manure which infected the milk or 
in the milk which infected the people. The water in which 
the cans stood, but which was not accused at all, was exam- 
ined ; no bacillus was found. The only really important work 
which the Connecticut board accomplished in this pretended 
investigation was to ruin the business and smirch the repu- 
tation of two unoffending citizens. Can it be possible that 
the board did not believe a word of their theory respecting 
the cause of the epidemic ? that for the glory of Sanitary 
Science and to inflate their own vanity they were ready to 
sacrifice the reputation and prosperity of two innocent men ? 
We are fain to think so; for we would absolve them from 
the cruel alternative, which is this, that if they believed what 
they said they were guilty of criminal negligence. There 
were at least sixty cart-loads of this manure the mass of which 
the reporter said was infected with typhoid-fever germs, yet 
the board of health allowed it all to go uncremated without 
a word of warning ; they did not even recommend its disin- 
fection. Those sixty cart-loads of manure were hauled out 
of the barn-yard, — so the farmer writes the author, — spread 
on different portions of the ground of a large farm, to be 
dried by the sun, blown by the wind, to be absorbed and 
filtered through the earth, infecting perhaps the air, water, 
and soil of the whole State of Connecticut ! 

The milk terror rcG^ardinsf tuberculosis is still hoverinsf 
over us. Frightful tales are told of ten, twenty, thirty, fifty, 
even sixty per cent, of some herds being afflicted with 



244 VAGARIES OF SANITARY SCIENCE. 

phthisis. There is no proof that the ingestion of meat or 
milk of tuberculous animals has ever caused phthisis in 
man. Although cases of this mode of infection have been 
sought for twenty years, the terrorists are constantly chal- 
lenged to produce a single instance. Bouchardat* says 
that, though there is not a single fact to establish the 
transmission of tuberculosis to man from milk, he thinks 
it is safer to boil that from a tuberculous cow. But, he 
asks, what inhabitant of Paris has not drunk tubercu- 
lous milk? The untutored man in Sanitary Science may 
— somewhat ostentatiously perhaps — apply the common- 
sense or ancestor argument here as he did about the ice. 
When he has recovered from his fright he will be likely to 
ask some questions. For example, if the bovine race is so 
thoroughly tainted with tuberculosis, and so prone to com- 
municate it to man, why is it that those who are constantly 
employed about these animals, who are handling their milk 
and manufacturing it into butter and cheese, are less subject 
to consumption than those engaged in many other employ- 
ments? Dr. Bryce, in a paper presented to the Conference 
of the State Boards of Health in Washington, May, 1 89 1, 
says that phthisis is twice as prevalent in our large cities as 
in the country. The common-sense man will inquire, If the 
bovine race is one of the great sources of propagation of 
this disease, who is it that those who are in daily contact 
with these animals are not nearly so likely to have the dis- 
ease as those why seldom or never come near them ? He 
will ask. If tuberculous meat can convey phthisis to man, 
why is it that butchers who slay these animals, and who 
are daily handling the meat, are not more subject to phthisis 
than many other persons who are not exposed to it, except 
as it is served to them after it is cooked ? He will ask, 
If one-third of the milk which is consumed is tuberculous 

* Traits d' Hygiene. 



THE MILK, 245 

and can impart tuberculosis to the consumer, why is it that 
those who take the most of this milk, at the most tender 
and susceptible age, — children under five years, — should 
only rarely have phthisis, and those beyond puberty, who 
take the least milk, should be the most obnoxious to the 
disease ? The common-sense man would like to know if 
the rule in Sanitary Science, that two and two make five, 
and that the less contains the greater, never suffers devi- 
ation. 

The common-sense man will ask why the people of those 
countries where neither flesh nor milk is eaten should be 
just as subject to phthisis as those who are large consumers 
of both. George Godet * says that the ox in Japan is of 
small size, and has always been reserved for agriculture and 
a beast of burden. It is only within the last ten years that 
he has served for food ; and that now there is hardly beef 
enough in Japan to supply the foreigners. Phthisis, he says, 
is common at Hakodate. Dr. Scheube f says that only very 
lately has beef been eaten in that country. In 1879 ^"^7 
twenty-four thousand cattle were slaughtered, and in 1880 
only thirty-six thousand. Butter and cheese are not made 
at all in Japan, and milk is taken only as a medicine. Dr. 
M. MiuraJ says that phthisis is a widespread disease in 
Japan {ausserordentlich verbreitet). In the five weeks end- 
ing August 2, 1890, three hundred and twenty-three deaths 
were reported as caused by phthisis in Tokio. 

Cattle in Alaska (Bancroft) are very scarce. The natives, 
being accustomed to fish for a diet, do not relish milk or 
flesh, and regard animals as a nuisance. Among the fatal 
diseases that prevail there, Bancroft names consumption as 
the first; then fevers, syphilis, and scrofula. On the other 



* Les Japonais Chez Eux, 188 1. 

f Archiv fur Hygiene^ 1 883, " Die Nahrung der Ja aner." 

X Virchoivs Archiv, 1885. 

21* 



246 VAGARIES OF SANITARY SCIENCE. 

hand, in Corea Dr. Koike * says that not less than three 
hundred thousand cattle are slaughtered annually, which are 
eaten by seven millions of people ; while in Japan not more 
than thirty-two thousand are eaten by thirty-seven millions 
of people. Dr. Koike says that phthisis is rare in Corea, 
though he frequently met with scrofulous children. Dr. 
Fuji f says that one of the least common diseases in Corea 
is phthisis. In the monthly return of cases in one hospital, 
from 1879 to 1884, three cases only were found. A Jap- 
anese physician told Dr. Fuji that he examined only one 
case of consumption in Corea between 1886 and 1889. A 
Corean physician assured him that the disease is seldom 
found among old people, and its scarcity everywhere in 
Corea is an undeniable fact. 

Every Friday in New York City, at the intersection of 
Ludlow with Hester Street, there is the centre of an open- 
air market which radiates west nearly to the Bowery. It 
almost touches Clinton Street on the east and south, and 
north it reaches close to Canal and Grand Streets. There 
is probably no such collection of people or goods to be 
found elsewhere in the world. Fish is for sale here at two 
cents a pound, eggs at six cents a dozen, and cheese at four 
cents a pound ; pineapples at three cents a-piece, and straw- 
berries at a cent a basket. Here are vegetables and fruits in 
such conditions of crudeness and decay that a man of sensi- 
bility would not feed them to his pig without first offering 
an apology. Here is poultry so emaciated that its bony 
anatomy can be studied without further dissection. Beef 
and mutton are. in much the same condition. Nothing but 
phthisis in its last stages could produce such leanness. 

Saturday nights on Ninth Avenue, between Thirty-sixth 
and Forty-second Streets, are offered the same kind and 

" Archiv fiir Ethnographie, •' Zwei Jahre in Japan." 
•}• Sei-i Kwai Medical Journal, 1890. 



THE MILK. 247 

variety of food, with the addition of pork. All day Saturday 
in the Italian quarter on Mulberry Street, between Chatham 
Square and Bayard Street, is a market superior to either of 
the others in neatness, but the merchandise here so tastefully 
displayed is the refuse of the better New York markets, 
-^sthetically considered, the food exposed for sale in these 
three markets should be swept into the sea or used on the 
land as a fertilizer. All of it is repulsive to the eye, and the 
most of it is disgusting to the nose. But, from an economi- 
cal point of view, its destruction would be a crime. The 
fact is, that tens of thousands of people consume it, and to 
all appearance thrive on it as well as their more fortunate 
fellow-men who purchase their supplies from more luxurious 
markets. It is doubtful if the former suffer as much from 
digestive symptoms as the latter, and that the consumption 
of the goods from any of these places can cause infectious, 
zymotic disease, or in any way imperil the public health, is 
pure absurdity. Nearly every week, however, a troop of 
urchins can be seen at the heels of some insolent official of 
the New York Board of Health who swaggers through 
these markets and orders the destruction of the stock of 
some poor, cringing vender who can ill afford to bear the 
loss, and whose goods if they were consumed would harm 
no one. The next morning the papers record the deed with 
approbation, and the people of New York for the moment 
breathe freer, in the trust that if a great disaster to the public 
has not been entirely averted, it has at least been postponed. 



248 VA CARIES OF SANITAR V SCIENCE. 



CHAPTER XII. 
Filth and Fecal Diseases — Typhoid Fever. 

At a very early period of the sanitary excitement the 
reformers were seized with the notion that certain diseases 
originated in filth, in putrid emanations and in drains ; and 
at length they grouped all epidemic and contagious disorders 
under the name of filth-diseases. At one time or another 
each disease of the zymotic class, no matter how specific 
might be its nature, was said to be not only propagated by 
filth, but actually to originate in and be created by filth. 
Could this be destroyed, the extinction of such diseases 
would necessarily follow. 

This idea permeates the whole mass of sanitary literature 
which has deluged the public for fifty years. It has never 
failed as a theme for the sanitary orator. It has been the 
basis of all sanitary codes ; has formed the groundwork for 
innumerable annoyances and prosecutions ; it has been the 
business foundation of boards of health. These proclaimed 
that privies, cesspools, sewers, and drains were competent to 
excite any and all of the zymotic diseases. The absurdity 
of this doctrine was so apparent that, after a i^v^ years, the 
craziest sanitarian forsook a portion of it. To have yielded 
it entirely would have sent the whole body of reformers into 
obscurity, unless some new device had been hatched to ter- 
rify the people ; so they proclaimed that diphtheria, typhoid 
fever, cholera, and yellow fever were dependent solely on 
filth, and that the last three were fecal diseases. No scientific 
inquiries were made previous to this manifesto to confirm its 
truth, and although the theory was as genuine a caprice as 
any which had preceded it, soon afterwards it became one 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 249 

of the " settled principles of Sanitary Science" that the source 
of these three diseases lay in human faeces. 

A glance at the process of digestion shows nothing on 
which to build this opinion. The food which largely sup- 
plies the entire human family, — except a few tribes, — and 
which is almost the sole nutriment of the majority of man- 
kind, undergoes decomposition as soon as it passes the lips 
and meets with the saliva. If nitrogenized aliment be taken 
also, both foods pass into the stomach, where they come in 
contact with a new fluid and ferment, which further disinte- 
grate and decompose them ; their original properties are lost. 
The result is, from the sanitarian's point of view, a mass of 
filth. It is giving forth gases which are identical with those 
which are evolved by putrefaction outside the body; but if 
these putrefactive and digestive changes were to cease we 
should die. They proceed until the contents of the stomach 
not directly absorbed into the circulation are poured into the 
small intestine, and the residuum of the contents of the small 
intestine are emptied into the large one. Here the deposit 
is retained for a variable period in different individuals, who 
may all enjoy the same measure of health. It may be evac- 
uated once, twice, or thrice in twenty-four hours ; or it may 
not be dismissed for two or three days. Through mechanical 
obstruction it may be held for many weeks without ever ex- 
citing infectious disease. In either event the act of defecation 
is as respectable as that of deglutition, or the intervening in- 
voluntary peristaltic movements. Because the final product 
suffers expulsion, it does not merit disgrace. It is just as 
precious as any that has preceded it ; and instead of being 
rushed ignominiously into a sewer, and thence into the sea, 
should be carefully stored for use in the soil. There a new 
career is prepared for it, where it can participate in new 
growths, — for therein lie the resurrection and the life, — and 
reascend in leaf and bud and flower and fruit, to be aeain 
appropriated by man and bird and beast. 



2 so VAGARIES OF SANITARY SCIENCE. 

That human faeces ever produced specific disease is a pure 
phantasy of the sanitarians ; they never offered any evidence 
to sustain the assertion ; there is nothing in analogy to sup- 
port it. The tree that sheds its fruit and leaves does not 
sicken and die when these decay through heat and frost and 
rain, and the resulting products are reabsorbed in trunk and 
limbs preparatory to another fruition. On the contrary, it 
will wither and fade if they are taken away and their place 
is not supplied by other putrefied matter. None of our 
domestic animals are made sick by contact with their own 
faeces, whether these are lately or remotely passed. 

But human excrement is the most dangerous and the vilest 
of all filth, say the sanitarians ; they neglect to furnish the 
proof. They never even made an investigation to obtain 
such proof. Long ago, Baron Liebig told us that human 
faeces were, in chemical constitution, almost exactly like 
guano; and the practical mind of that philosopher was 
grossly offended that the English should pour their sewage 
into the ocean, and then send ships fifteen thousand miles 
away over the same ocean to bring back the faeces of birds, 
to repair the loss of the wasted faeces of men. He contrasted 
this prodigahty with the economy of the Chinese, who, since 
the building of the pyramids, had made their soil not only 
to support the swarming millions in China, but to contribute 
widely to the food-supplies of other nations. He declared 
that the example of the coolie, who, after the sale of his 
produce in the town, invariably transported human excre- 
ment back to his home to renew the fertility of his land, 
should be followed by every' European farmer who took his 
sack of grain to market. He warned the people that the 
supply of guano would some time be exhausted ; that famine 
awaited the nation that did not return to the soil those ele- 
ments which had been abstracted from it by vegetable growth; 
and that every scrap of animal refuse, — blood, bone, muscle, 
sinew, and fat, — and every pound of human faeces, and every 



FILTH AND FECAL DISEASES— TYPHOID FEVER, 25 I 

ounce of human urine, should be saved, that they might 
perform the dignified office of restoring the equilibrium of 
the soil, to the end that the human race might not disappear 
from the face of the earth. That the shallow mind of the 
sanitarians could comprehend any of these considerations 
was not to be expected ; besides, their standing as scientists 
and, to a great extent, their revenue depended on perpetu- 
ating the terror respecting the power of human faeces to pro- 
duce disease ; and we were told that there was nothing in 
Sanitary Science better established than the fecal origin of 



TYPHOID FEVER. 

If this now ubiquitous disease afflicted mankind before the 
beginning of the present century, its distinction from other 
forms of fever was not recognized by physicians. In 181 3 
Petit and Serres made known that in one form of continued 
fevers the glands of the mesentery and intestines suffered a 
lesion. They called this disease la fievre entero-mesenteriqiie, 
and said that it had been seen in Paris for eight years. " La 
fievre entero-mesenterique," they ask, " est-elle distincte des 
autres ? Est-ce une maladie nouvelle dependante d'une con- 
stitution atmospherique ?" They remarked that it attacked, 
for the most part, young people lately arrived at the capital ; 
that youth and change of abode were predisposing causes ; 
they said nothing further respecting its etiology. In 1829, 
Louis published a voluminous work of nearly a thousand 
pages, wherein, through the most laborious and exact inves- 
tigation, he seeks to illustrate the morbid anatomy, symp- 
toms, diagnosis, causes, and treatment of the disease, which 
he calls affection typJwide, and which has since been known 
all over the world by physicians as typhoid fever. The key- 
note to the whole book lies in the motto, from Emile, which 
decorates its title-page. *' Je sais que la verite est dans les 
choses, et non dans mon esprit qui les juge, et que moins je 



252 VAGARIES OF SANITARY SCIENCE, 

mets du mien dans les jugements que j'en porte, plus je suis 
sur d'approcher de la verite." 

It is not too much to say that, except for the aid the ther- 
mometer has bestowed in proving the diagnosis and assisting 
the prognosis of this disease, and except for the latter bio- 
logical researches respecting its bacillus, nothing of a truly- 
scientific character has been added to our knowledge of the 
causes, symptoms, pathology, or treatment of typhoid fever 
since Louis put forth his work more than sixty years ago. 
Except age, change of habitation, — perhaps sex, — which 
favor its development, the causes of this disease, he says, are 
unknown (" La plus profonde obscurite regne done sur les 
causes de I'affection qui nous occupe"). 

Five years later (1834), Chomel (" Fievre Typhoide") says 
that the causes of this disease are wrapped in the deepest 
obscurity ; that we know some of the circumstances under 
which it develops itself with a marked preference ; but that 
the determining cause has so far escaped investigation ; that 
misery, famine, fatigue, or mental anxiety may have some- 
thing to do in its production, but that none of these is the 
cause. Littre,* still later, declares that there are no known 
causes of this disease. Bartlett f says that the only causes 
ot typhoid fever the influence of which he has positively 
ascertained are age, recent residence, and contagion. The 
actual producing, efficient cause, like that of most other dis- 
eases, is unknown to us. Dr. Jackson % supposed it to be 
connected with the soil, " although not at all depending upon 
any filth or decomposing substance, since no such could be 
discovered, and since the houses were often new, clean, and 
in good situations." 

Without making any new discoveiy, or even any new 
investigation whatever, the more noisy promoters of sanitary 

* Dictionnaire de M^decine, article " Dothinenterite." 
I 1847. X Bartlett, p. 90. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 253 

reform began, very early in the movement, to declare that 
this fever originated in drains, sewers, and putrid emana- 
tions ; and by 1 862 it was rechristened pythogenic fever by 
Dr. Charles Murchison, who said that it is " generated and 
probably propagated by certain forms of decomposing 
matter." Facts were tortured in every conceivable manner 
to fit the new theory. Sometimes the incubative period of 
the disease was only a few hours, as at Croydon in 1852, 
where it " immediately followed" exposure to fetid emana- 
tions ; or it might be forty-eight hours, as at Clapham, or be 
extended to three, or four, or six weeks. 

A favorite way of accounting for an epidemic of typhoid 
fever was through the defilement of drinking-water by the 
proximity of privies or cesspools. It did not matter if it 
was shown that such water had been drunk for generations 
without having caused disease ; it did not matter if it was 
shown that, in an infinite number of localities where there 
was no fever, the water for domestic purposes was proved 
to be more impure than where the fever occurred. 

It should be kept in mind that no experiments had ever 
been made to show that it was possible for typhoid infection 
to filter through the earth from a privy to a well. Dr. 
Franz Hoffman * showed that it required three months for a 
solution of common salt to pass a distance of twenty inches 
through the soil of the cemetery at Leipzic, and to pass less 
than ten feet it would require four hundred and eighty-four 
days. In ground like the streets of Leipzic the same solu- 
tion would not pass ten feet in less than seven hundred and 
thirteen days. Unless positive proof is offered to show the 
power of typhoid-fever infection to pass through the soil, is 
it not an absurdity to suppose it possible ? 

At Trinity College f there was an outbreak of the disease 



* Archiv filr Hygiene, 

f BHtish Medical Journal, April lo, 1S69. 



254 VAGARIES OF SANITARY SCIENCE, 

where the water was found to contain a large percentage 
of organic matter ; but this water had been used for thirty 
years, and the college had had immunity from this fever 
during that time. Besides, within a year new sanitary im 
provements had been added, and the fever was limited to 
that part of the college where the best sanitary conditions 
prevailed. 

Sometimes the water absorbed sewer-gas, as at Croydon 
in 1876; sometimes mud or a dead turtle, or a dead mouse 
was found in the bottom of a well, or some cows had drunk 
polluted water. In the mind of the sanitarian, any one of 
these events sufficed to account for a wide-spread epidemic. 
Again, decomposing twigs or leaves in water were enough ; 
and two cases of typhoid fever are reported, in all sober- 
ness,''' where no other cause could be found than the evacu- 
ation of a Newfoundland dog ; and the reporter thinks that 
this gives a clew to explain why this disease so often attacks 
the rich ! Room is found in two or three numbers of the 
Lancet for the discussion of this canine etiology of typhoid 
fever. It breaks out in Dublin in 1891. Prince George is 
seized with it. Bad smells from water closets had caused it 
twenty and thirty years before, when his father and grand- 
father suffered with it. In the prince's case no effort was 
made to show that he had honored any disreputable privy 
with his visits. It was found out, however, that he had 
eaten oysters at Dublin, and it is now asserted that these 
had taken up the typhoid germ which had been transmitted 
to the oyster-beds through the sewers, and thus had infected 
the prince. It might be thought by those unfamiliar with 
the methods of the professors of Sanitary Science that the 
germ had been discovered in the oysters or in the beds, or 
at least in the sewers which led to them. Not at all. It had 
not even been looked for. 

* London Lancet^ vol. ii., 1875. 



FIL TH AND FECAL DISEASES— TYPHOID FE VER. 255 

If an epidemic broke out in a poor portion of a town, it 
was ascribed to the privies in the yard. If a well-to-do part 
was attacked and the poorer people escaped, it was because 
the former used water-closets in their houses, and the latter 
were supplied with privies. 

In reality, the history of the rise and progress of this fever 
in Great Britain is contemporaneous with the rise and prog- 
ress there of sanitary reform, and from its first appearance it 
continued its ravages, as typhus and other diseases had 
before it, and as diphtheria did later, in spite of, and 
without any regard to, sanitary measures. Before its recog- 
nition in Great Britain the reputed causes of the disease 
were not absent. There was no lack of fecal deposits. 
Private and public water-supplies were polluted with twigs, 
trees, and stumps, and were just as unprotected from sub- 
terraneous connections with leaky privies and cesspools, and 
the water from them was used to cleanse milk-cans ; un- 
trapped house-drains were just as common; heedless turtles 
tumbled into wells; frolicsome dairy-cows wantoned in 
puddles of (dirty water; Newfoundland dogs were petted by 
the rich ; royal Georges had stuffed themselves with oysters ; 
yet, with all of these multiplied agencies, any one of which, 
the sanitarians say, is competent to produce enteric fever, 
it was unknown and unsuspected in that country before the 
third decade of the present century. 

This filth-doctrine of the etiology of typhoid fever was, 
from the first, sharply contested by such men as Professor 
Christison, W. P. Alison, Hughes Bennett, Stokes, and 
Graves, and by many medical men of lesser note. They de- 
clared that it was inconsistent and irreconcilable with facts. 
Dr. Smith * writes that he had observed thirteen thousand 
cases ; that whatever may be said of the new fever (typhoid) 
being generated by overcrowding, filth, impure air, poverty, 

* Edinburgh Medical and Surpcal Journal. 



256 VAGARIES OF SANITARY SCIENCE. 

and such like, facts seem still to be wanting to establish the 
theory, or to give it even a semblance of plausibility. 

Dr. W. P. Alison * says that the opinion that putridity 
generates fever is not only speculative, but that ample expe- 
rience shows it to be erroneous ; that, though it has often 
been supposed by medical men to be the cause, yet the 
greater number who have carefully investigated it have 
rejected the theory. He had observed fever in Edinburgh 
for twenty-five years. Hundreds of times he had noted 
places with putrid effluvia, but the same places were free 
from fever for years together. In his own time the city had 
been much improved, so far as cleanliness was concerned ; 
but there had been no corresponding improvement in the 
health of the city ; and for the last three years fever had 
been more wide-spread and more fatal than ever before. 
When it does prevail, it is not among the filthiest, but among 
neater and better-ventilated, parts and people. 

Dr. Christison said that it was not until 1847 that tj'phoid 
fever began to be studied with care in Edinburgh. By and 
by it became common, and is now (1863) encountered, not 
as typhus was, among the destitute, but among those in 
easy circumstances and in the best houses. Of all forms of 
fever, none had been so confidently ascribed by some writers 
to filth. " Has London," he asks, impatiently, " been worse 
drained, or the habits of its people alternately been more or less 
cleanly, as this fever has been alternately growing or dimin- 
ishing in London ? . . . Does it generally appear where the 
drainage is bad and the water-closets faulty ? > . . Our drains 
in Edinburgh have been very much improved during the very 
period that typhoid has been increasing ; besides, cases are 
occurring where it is impossible to discover foul air, any 
more than in thousands of houses where it does not occur. 
. . . The majority of deaths, so far this year, happened in 

^ Observations of the Generation of Fever. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 25/ 

localities to which no objection could be made. . . . Fur- 
ther, this fever does not break out where the streets are ill- 
drained and the habits of the people filthy. ... In count- 
less places of that sort in Edinburgh it is unknown." Dr. 
Christison concludes that we do not know the cause of this 
diseas^e, as of other epidemic diseases. 

While Dr. Graves * admits an advancement in public 
health from drainage, improved habits, and increased com- 
forts, he believes that the increase or diminution of fever 
arises from some unknown cause, independent of locality or 
drainage. 

Dr. Hughes Bennett says that we have emanations with- 
out epidemics, and epidemics without emanations. He 
sees no connection between the two conditions. When 
in Naples, in 1863, he found the city full of the vilest odors : 
for half a mile from the inner margin of the bay the water 
was like turbid pea-soup, and there was a constant smell of 
sulphuretted hydrogen. Here it might be supposed enteric 
fever would prevail. There were one thousand beds in one 
hospital that he visited; the ammoniacal exhalation from 
the water-closets here " was something astounding." " Yet 
the reply, on inquiry, was that typhoid fever was trifling." 
Again, in the military hospital, with similar arrangements 
and disgusting emanations, but one case of fever was all that 
could be discovered in eight hundred beds. The director 
of the hospital certified that no typhoid fever arose from the 
latrines. Naples was in a deplorable condition, but it was 
no more subject to typhoid fever than other cities. Foul 
smells and fetid exhalations have been escaping from the 
irrigated meadows at Edinburgh for two hundred years; 
" yet, notwithstanding the magnitude of the nuisance, enteric 
fever in that locality had never occurred." Dr. Stokes f 
says that the origin of this fever is one of the most difiRcult 

* Clinical Medicine, f Continued Fever. 

r 22* 



258 VAGARIES OF SANITARY SCIENCE, 

and obscure subjects in the whole range of physical in^ 
quiry. 

Dr. Grabham * writes that, while he does not deny the 
possibility of typhoid fever arising from polluted water, yet 
" it is vain to seek to trace many well-marked cases of pure 
typhoid to sources of filth-contamination." In Madeira he 
has, again and again, seen such cases occur in the persons of 
young, healthy new-comers, in situations many hundred feet 
above the city, far away from all dwellings or sources of 
filth, and with the drinking-water flowing from springs 
beneath basaltic columns of rock. 

Dr. Elliot Laine says that in Australia, where he has 
been for six years, he has cases exactly similar to typhoid 
fever, except for the rash, brought in from the bush, where 
the subjects have been exploring for new squatting-ground. 

Dr. Bakewell f tells of an epidemic of typhoid fever that 
broke out on an emigrant-ship, after it had been a month at 
sea. He apologizes that he, an unknown practitioner, should 
presume to criticise Sir William Jenner as to its etiology, but 
thinks he may " be pardoned" if, after having treated typhoid 
fever in London, the rural towns, the Crimea, Australia, and 
the West Indies, for thirty-two years, he has ^* an opinion 
of his own." 

Sir Joseph Fayrer % says, " A form of fever exactly like 
European typhoid, except in its etiology, exists in India and 
other hot and malarious countries ; and it is due to climatic 
causes, not to filth or specific causes." " Enteric cases are 
reported from nearly every station in the Bengal presidency, 
where the filth-element is at its minimum." He offers the 
testimony § of Surgeon Ryley, who, as the result of sixteen 
years' experience in New Zealand, Fiji, New South Wales, 
and Australia, says that a fever having all the characteristics 

London Lancet, vol. ii., 1879. f Ibid., vol. i., 1880. 
X Ibid., vol. ii., 1879. \ Ibid., vol. i., 1880. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 259 

of typhoid occurs in those countries, as in England ; that 
in no case could he trace it to contagion ; that in a few in- 
stances it seemed to have arisen from foul drinking-water, 
but in the majority of cases it has broken out among Euro- 
peans, " new-comers," first inhabiting a virgin soil, apparently 
from paludal emanations or other climatic causes. 

Of this disease in India, Surgeon-General Ker Innes* 
says, " It cannot, except in some rare instances, be traced to 
importation from England, nor to fecal contamination of 
air, water," etc. ; and *' medical officers have utterly failed 
in India to trace out the ultimate connection of this disease 
with filth-causes or specific infection, with which, according 
to European authorities, it is invariably associated." 

Surgeon Kavanagh says that he is convinced that it is an 
error to seek for the unsanitary starting of this fever out- 
side, and he suggests that inside the body decomposing sub- 
stances are capable of producing it. Surgeon-General 
Gumming says that typhoid fever in India is, in the main, a 
disease of the young, and occurs chiefly in Europeans new 
to the country. The importation and germ theories will 
not account for it. Enteric fever in India is the result of 
climate telling on constitutions unaccustomed to the strain, 
and is favored, as all diseases are, by local unsanitary con- 
ditions. In the report of Indian health statisticsf it is stated 
that in the great majority of instances ** no clew whatever 
can be found to the causation of the disease (typhoid) in 
any local unsanitary conditions." 

Fleet-Surgeon Norbury| entirely agrees with those au- 
thorities who think that typhoid fever arises de novo. 
From January 23 to April 4, 1879, his command was 
practically cut off from the outer world. Before the march 
away from this base no case of this disease had been heard 
of, neither was it known at Elkowe, the termination of the 

* London Lancet, vol. ii., 1879. f Ibid., vol. i., 18S6. \ Ibid. 



26o VAGARIES OF SANITARY SCIENCE. 

march. Yet many cases of typhoid fever broke out at 
Elkowe. Surgeon Norbury thinks it is as nearly proved as 
it can be that typhoid fever can arise de novo. 

The number of English troops in India * is sixty-two 
thousand. Enteric fever is the most fatal of all diseases. 
In Bengal, " at none of the stations could the origin of the 
disease be traced to local conditions," and the conclusion 
arrived at was that " it was due to climatic effect in young 
or recently-arrived soldiers." In Madras, " at none of the 
stations could any definite cause be assigned for the prevalence 
of enteric fever." At Bombay it was the most fatal of all 
diseases ; " at none of the stations could an.y local cause be 
traced." 

Sir Joseph Fayrerf says that enteric fever occurs in 
India, as it does in England, but " fever in India with diar- 
rhoea, peyerian ulceration, and typhoid symptoms is not 
necessarily caused by a specific contagion derived from fecal 
matter or from the intestines of another person." It was 
not, he says, until 1853 that it was suspected that persons 
died of enteric fever in India. In a few years it became a 
prevalent and fatal form of disease, especially among young 
and susceptible Europeans, and it is now the " chief fever 
death-cause among our young soldiers in that country." 
He quotes Dr. Gurdon, late chief of the medical service at 
Madras, who says that enteric fever occurs in India " that 
cannot be traced to anything pythogenic or otherwise spe- 
cific." 

Deputy Surgeon-General Alexander Smith " denies the 
specific origin of enteric fever, and attributes it to general 
and climatic causes." Dr. Alfred Clarke, of the Army 
Medical Department, says, " I have seen enteric fever in 
India where all filth-causes, in the ordinary sense of the 
term, are absent." 

* London Lancet, vol. ii., 1888. f Croonian Lectures. 



FILTH AND FECAL DISEASES— TYPHOID FEVER, 26 1 

Dr. Bryden asks, if enteric fever is due in India to fecal 
emanations, " how can we explain the fact that, in the 
midst of the city of Dacca, containing, as it did in 1872, 
sixty-nine thousand inhabitants, densely-populated quarters 
are to be seen, in which the fecal deposits of generations 
are collected in unsightly heaps, or thrown into privy-wells 
within a few feet of the wells from which drinking-water is 
obtained, which causes diarrhoea when first used, but never 
any form of fever is observed ? Toleration is soon estab- 
lished and comparative health enjoyed." The Dacca jail 
and lunatic asylum stand side by side, on the driest and 
most elevated piece of ground within the city. No water- 
lodges and no sewers exist. The dry-earth system is fol- 
lowed ; night-soil is buried in the gardens and vegetables 
are planted therein. The drinking-water is pure ; that for 
the lunatics is filtered through charcoal and sand. No out- 
break of fever has occurred here ; but isolated cases are 
met with, at intervals of weeks and months, which refute 
the idea that the seizures are due to any local defects within 
the walls. 

Brigade-Surgeon Marston writes, "I came out here (India) 
imbued, rather than otherwise, with a belief in the truth of 
the views of European pathologists ; but Indian experience 
has compelled me to recognize that those views as to the 
causes of enteric fever are too exclusive and quite inade- 
quate to account for the facts." 

Surgeon-Major Clark reports to Sir Joseph Fayrer from 
Natal and Zululand that enteric fever occurred there in 
healthy camps on virgin soil, and in bodies of picked men 
where the water-supply was good, no sewers, no drains, dry- 
earth, and trenches carefully attended to. Staff-Surgeon 
McLean * writes that if enteric fever is always associated 
with defective sanitation, " then Ascension, of all places 

* London Lancet^ vol. i., iSSo. 



262 VAGARIES OF SANITARY SCIENCE. 

with which I am acquainted, ought to be exempt from it. 
There is no such thing as a sewage-drain or a cesspool on 
the island, all sewage and other filth being removed daily 
and thrown into the sea to the leeward of all dwelling- 
houses." But he adds, " Cases of this disease have occurred 
from time to time without any discoverable connection with 
each other. My investigations have utterly failed to connect 
the fever with any of the conditions commonly believed to 
be essential to its production." 

Surgeon-General Marston * says that none of the theories 
that prevail in Europe can account for it in India, — neither 
filth nor contaminated water nor specific infection. He 
concludes that change of climate, surroundings, diet, acting 
on young, recently-arrived soldiers is sufficient to cause the 
disease. 

In 1 890 1 enteric fever in India caused thirty-seven per 
cent, of the total mortality, against twenty-five per cent, for 
the previous year. In Bengal the mortality from this dis- 
ease was forty-two per cent., against twenty-seven of the 
year before, and in Bombay it caused forty per cent, of the 
deaths. Dr. Ferguson % relates epidemics of typhoid fever 
in his command at Bermuda ; he " could not trace it to any 
defective sanitary arrangement." " The dry-earth system 
was adopted." " The water used was rain collected in 
tanks removed from any possible pollution." Dr. Ham- 
ilton § says of typhoid in India, " In no part of the world is 
sanitation so perfect as in India, and in no station could the 
dry-earth system be more thoroughly carried out than here. 
Yet year after year, with the advent of young soldiers from 
home, we see the same recurrence of the disease." 

Dr. Thomas || reports that the sanitary arrangements of 



* Notes on Typhoid Fever in India. 

f London Lancet, vol. i., 1891. % Ibid., vol. i., 1880. 

\ Ibid., vol. ii., 1888. \\ Ibid., vol. i., 1880. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 263 

Algiers are bad, the system of water-closets imperfect, and 
bad smells only too common. Dr. Robertson says that at 
the principal hotel here the water-closets all open into one 
shaft without proper traps, and the closets and corridors 
are in direct communication with the sewers of the town. 
Dr. Thomas says that one thousand English visitors have 
been here the last winter, " not one of whom has suffered 
from typhoid fever." 

In August, 1889, typhoid fever breaks out in London at 
West End. The Lancet says it is impossible that it can be 
due to unsanitary condition of the houses, and it suspects 
the milk. Further investigations fail to reveal any cause. 
It breaks out the same year in the stock exchange. The 
cause is not the general insanitation of the building, and 
there is no record that it is ever ascertained. It breaks out 
at Tullamore jail ; * an investigation shows that " the sani- 
tation of the building is perfect." The town is " devoid of 
sanitary arrangements," but no typhoid is reported in the 
town. 

Dr. Tew f personally investigated one hundred and two 
cases of typhoid fever in 1890. Five per cent, were traced 
" without reasonable doubt" to specifically polluted water. 
He does not say that the bacillus was found in the water ; 
while in twenty or twenty-five per cent, the water was of 
inferior quality, he does not say in what respect it was infe- 
rior. He thinks that although water-supply and drainage 
are important in considering the causes of this disease, in- 
quiries into the fruit, vegetable, and meat suppHes are of 
increasing importance. 

Typhoid fever is reported at Dublin in 1891 ; | as regards 
the cause " no special light has been obtained." ** Sir Charles 
Cameron, the medical officer of health at Dublin, reports the 



* Medical Press, 1 89 1. f Lancet, vol. i., 1S9] 

\ British Medical Journal, 



264 V^A CARIES OF SANITARY SCIENCE. 

sanitary condition of the city good. The epidemic, he says, 
is not " due to the defective state of the sewers and accom- 
modations." " In seventy-five per cent, at least of the cases 
no sanitary defects were observed." " The disease seems to be 
more prevalent among the upper and middle classes." The 
only explanation he gives of the epidemic is that " it is a dis- 
ease the germs of which exist in the soil, and ascend from it 
into the atmosphere at some seasons in greater numbers than 
at others." Dr. Cameron does not condescend to explain why 
these germs ascending at certain seasons of the year should 
have such malignant effect in 1891 on the upper and middle 
classes of Dublin. M. Rochard * insists on overcrowding 
as a cause of typhoid fever. The French naval vessels, he 
says, are extraordinarily (exageree) cleanly ; the men in this 
respect are irreproachable; water is taken from sources 
specially selected for purity; the excrements fall into the 
ocean ; yet in our national as well as in our emigrant ships, 
typhoid fever appears when people are crowded together 
[dans les milieux encombres). 

Vienna, which for some years had been only lightly 
visited with typhoid fever, experienced in 1882 a serious 
increase in the number of cases.f The examination of 
water, well, and spring gave negative results. The reports 
of the physicians detailed the condition of the houses, 
habits, diet, and pursuits of patients, the quality of the water 
they had drunk, the situation of wells, privies, and cesspools, 
and the cleanliness of yards. No origin could be assigned 
for the increase of the fever. L etude de ces rapports n'a pas 
permis jusqu'ici d'assigner une origine nettement detertninee 
a la recrudescence de la maladie. 

The commission appointed to report on the severe epi- 
demic of typhoid fever at Zurich % say that poor and rich 
were alike affected ; density of poj^ulation had no influence 

* Annales d'Hygiene. f Rez'ue d" Hygiene, 1890. % Ibid., 1885. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 26$ 

on it ; neglected and bad-conditioned privies seemed to be a 
protection against the disease rather than to favor its devel- 
opment ; it was improbable that the air of sewers had any 
influence to spread it ; neither was it affected by meteor- 
ological changes. All sorts of bacteria were discovered 
except the typhoid. The commission declared it could not 
give the origin of the epidemic. 

The filth theory of this disease, especially the polluted- 
water part of it, was received from the beginning by the 
Germans with derision and contempt. It was more kindly 
entertained in our own country ; indeed, the Anglomaniacal 
sanitarians here adopted it without hesitation. In the Sani- 
tarian * we are told that typhoid fever is traceable to filth 
with as much certainity as smoke is to fire, and is a disease 
wholly preventable' by proper sanitary measures. During 
the Newport excitement it was declared that scarlet fever 
" originates in filth" and is fostered in filth ; and that typhoid 
fever is " purely a filth-disease, and only spread through filth- 
exposure." The Massachusetts Board of Health, however, 
was a Uttle doubtful after its first investigation ; for it said f 
we must believe that English drinking-water is " exception- 
ally dirty, or that medical observers are unconsciously 
influenced by preconceived opinions, based upon the inge- 
nious speculations of men of ability, who have directed their 
attention to this form of danger." The board said, if this be 
the cause, we should expect to find this disease most frequent 
and virulent where privies and wells are in closest prox- 
imity. " There are many towns in Massachusetts where the 
surface of the ground is dotted all over with these structures. 
There are a very large number of towns with a population 
of from five thousand to ten thousand, compactly built, with 
no water except from wells, and no means of disposing of 
their excrement except by privies ; and we know from the 

* 1880. t Report, 1 87 1. 

M 23 



266 VAGARIES OF SANITARY SCIENCE. 

registration returns that, in proportion to population, the 
people of these towns are more free from the pest of typhoid 
than the inhabitants of agricultural districts." "If we may- 
deduce any conclusion from the mortality in Lowell for a 
single year, it would appear that, though filth, putrid air, and 
impure water are active agents in causing scrofulous, tuber- 
culous, and bowel diseases, they have but little, if any, power 
to produce typhoid fever." For two years, 1869-70, in 
Lowell, a very much greater number of deaths had occurred 
from typhoid fever in good localities than elsewhere, and only 
a very few in places that were pronounced bad. In that city * 
the number of deaths from typhoid fever in the worst locali- 
ties was five ; in localities somewhat better, five ; and in well- 
ordered sections the number of deaths was twenty-six. To 
the question that the Massachusetts Board sent to different 
towns, as to whether any variation had been observed in the 
prevalence of typhoid fever between families that used spring- 
water and those which used w^ater from wells, there were 
ninety-four replies. Twenty-three said yes ; seventy-one said 
no. In 1 87 1 ten towns reported no typhoid fever; and in 
some it was said that the disease was almost unknown. 
Wherein these towns differed from others is not stated. 

The disease prevailed at West Boylston, but the cause was 
not obvious. The physician from Watertown writes that he 
has " diligently searched for some local cause ; but, except 
in one case, has never been able to discover any satisfactory 
one." The doctor at Worcester has " never been able to 
trace the disease to any particular cause." Another physi- 
cian in Worcester can find no cause. Still another says, 
" The worst cases have been on high ground, and under 
apparently the best hygienic influences." At Chester and 
Cambridge no cause could be found. At Coleraine, " often 
the most negligent families seem to escape." To the physi- 

* 1871. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 26/ 

cian who reports from Franklin it seems strange that he sees 
so many places where sink-water is deposited at the back 
door and no evil results follow. ** On the other hand," he 
says, ** I have had cases in families where the surroundings 
seem conducive to health." In Salisbury and Swampscott 
no cause could be found. In Orleans was an unusual 
amount, confined to the highest, driest part of the town. 
The people use cistern-water, and the cisterns were cleaned 
three months before fever broke out. There were no cess- 
pools here, nor other filthy deposits ; cellars were dry, and 
free from decaying vegetables. 

Among the specified causes of this fever, which are given 
by some of the Massachusetts physicians, are swamps, 
drains, decaying vegetables, low water in ponds, heavy 
rains, pools of water, wet cellars, a cider-mill, a slaughter- 
house, swimming in a foul pond, repairing an old house, 
putrid fish as manure, cesspools, decaying wood, clearing up 
the soil, open drains, stopped-up drains, cleaning a cellar, 
bad wells, privies, etc., etc. 

The Massachusetts Board says * that this fever does not 
prevail most in the filthiest towns, nor in the filthiest parts 
of towns, nor in those years in which filth is most accumu- 
lated ; and in the sense of being an index of filthiness, it is 
very far from being a filth-disease. It goes on to declaref 
that there is an " unknown factor" in this disease, of which 
we know as little as we do of the germ. " If we ignore this 
* unknown factor,' it must be admitted that the negative 
evidence enormously preponderates over the positive facts, 
which tend to show that filth, independently of a specific 
poison, produces typhoid fever." The board says, further, 
that the evidence seems to be that filth " plus an unknown 
factor" is sufficient. This is a practical abandonment of the 
case ; for the board's own reports show that, in a great 

* Report, 1879. fP- xviii. 



268 VAGARIES OF SANITARY SCIENCE. 

number of cases, the " unknown factor," without the filth, 
has produced the disease. Really, the cause, pure and 
simple, of typhoid fever in Massachusetts, is the " unknown 
factor." 

In 1882 * a severe epidemic of typhoid fever broke out in 
New Haven. The untutored man in Sanitary Science will 
say, of course, that it started, at least, among those citizens 
who have been so carefully storing up their filth close to 
their houses. Not at all. It broke out in Yale College, 
and some weeks later spread from thence to houses in the 
town. Professor Brewer, a member of the Board of Health, 
certifies to President Noah Porter that New Haven is an 
unusually healthy town, and that the late typhoid fever in 
the college could be traced to no local cause. Four months 
before, the entire plumbing had been renewed, and Professor 
Brewer described it as " the most elaborate and expensive 
that has yet been devised." 

In 1884 a circular was sent to the physicians in Connec- 
ticut, inquiring for any cases of typhoid whose origin was 
from foul drinking-water or other local conditions. The 
secretary of the Connecticut Board of Health says that the 
reports " will confirm the teachings of the best sanitarians 
in regard to the close and dependent relation of disease to 
surrounding conditions." There were one hundred re- 
sponses. Seventy-three did not answer the question at all as 
to the cause of typhoid fever. Ten said plainly that there was 
no local cause. Dr. Hill, of Stepney, said that malaria had 
" squelched" typhoid. " It must have removed our filth and 
purified our drinking-water." Dr. May found the disease 
where the water was pure and the sanitaiy condition the 
very best. Dr. Pinney said that it was dependent on some 
cause too subtle for him to detect. " In fact," he adds, " the 
general sanitary condition is better, but the typhoid is 

* Connecticut Board of Health Report, 1883. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 269 

more." In Suffield it occurred in one of the healthiest 
highest, and driest localities, with absolutely no unfavorable 
surroundings. Dr. Newton writes, " We find this fever on 
high ground and sanitary condition perfect." He believes 
it is due to climatic influences, and not to filth. Of the 
fifteen who mention a cause, three say drinking impure 
water, five lay it to cesspools, three to pouring slops on the 
ground, one to wading in a muck-pond, one to a damp 
cellar, one to a privy, and one to a place where was " for- 
merly some filth !" 

The Connecticut Board of Health Report for 1887 pre- 
sents the results of another official inquiry among the 
physicians of the State concerning the cause of typhoid 
fever. One hundred reported more or less of the disease. 
Eighty- two of the reports did not allude to the cause. 
Eleven named some cause, — three, polluted water ; one, dis- 
turbing the soil ; one, a garbage-heap ; two, imperfect sew- 
erage ; three, sink-drains ; and one, " may have been a 
sink-drain." Seven said plainly that there was no cause. 
Dr. Goodwin, of Thomaston, said that it was impossible to 
trace the cause in any case. Dr. Smith was able to trace 
the real source in none. Dr. Worden could tell of no 
reason why it prevailed in Bridgeport with unusual severity. 
Dr. Lewis writes, " Careful search fails to find the cause." 
Drs. Young, Fox, and Brown could find no cause for the 
disease. It occurred in one locality in Middletown where 
there was no imported case and no other cases in the 
vicinity. Here it was ascribed to pouring slops on a rasp- 
berry-patch four month'i before ! 

An epidemic occurred in Madison, and the secretary of 
the State Board of Health investigated its source. He says, 
" There are no facts respecting garbage, sewage, cesspools, 
pig-styes, barn-yards, or privies, which have been discovered, 
to distinguish the houses in which the fever occurred from 
other houses." He ascribed it to low water in the wells. 

23^ 



270 VAGARIES OF SANITARY SCIENCE. 

But the water was just as low in the wells of adjoining 
towns where there was no fever, and it was never explained 
why low water in the wells should cause typhoid fever in 
Madison and prevent the same disease in the towns of 
Guilford and North Haven. 

In 1890,* to the question whether typhoid fever could be 
traced to any special cause, the reporters from sixty-six of 
the towns which reported more or less typhoid made no 
reply. Thirty-two said distinctly that no cause for the dis- 
ease could be traced. Dr. Goodwin, of Thomaston, said, 
" After careful search and inquiry no cause could be found." 
Some cause was assigned by twenty of those who reported 
on the disease. One physician writes that the cause in one 
case that he had was " a duck-pond," but he could not trace 
the cause of the other cases. Nine report bad wells, or 
suspected wells, though no report is made that there was 
any examination of the water. One was caused by a filthy 
cellar ; bad locations caused it in three cases ; low ground 
and bad water in another ; six accused faulty drains ; and 
in one instance there was an " unsanitary condition." Dr. 
Brownson, of New Canaan, writes that he has searched dili- 
gently for causes of typhoid fever, and believes that they 
are beyond our knowledge. In the Connecticut report for 
1 89 1 are recorded the replies of physicians to the question 
if typhoid fever could be traced in any case to a specific 
cause. Sixty-six said plainly no cause could be found. 
Many of these stated that they had carefully searched for 
the cause. Forty-eight made no reply to the question. 
The disease was unusually prevalent at Bridgeport. The 
county jail was the nucleus. Of course the reader will say 
it was due to the vile sanitary condition of the jail, de- 
cribed on a previous page. Not so. Dr. Werdon writes, 
" All the cases occurred in the new building, the sanitary 

* Connecticut Board of Health Report. 



FILTH AND FECAL DISEASES— TYPHOID FEVER, 2/1 

outfit of which is thought to be complete. Careful inves- 
tigation failed to reveal a cause for the disease." 

The New Hampshire Board of Health * announces that 
the evidence is overwhelming that typhoid fever is a filth- 
disease. In the same report, however, fifty physicians who 
report on it say no cause could be found. Sixteen others 
make no allusion to the cause. Five are particular to say 
that the sanitary condition was good where it occurred. 
Twenty-five say bad water was the cause, though there is 
no record that the water in any case was examined. Be- 
tween thirty and forty others give a variety of causes, as a 
foul cellar, filth, sewer-gas, overwork, a pond of water, a 
dry pond, poverty and filth, lying on the ground, smell from 
a carcass, contagion, etc. Dr. Blaisdel said his cases " were 
surrounded by unusually good hygienic conditions, and the 
water-supply was better than the average." Dr. Tucker 
said he had given very careful attention to learn the cause, 
but had " utterly failed" to find it. 

Dr. Cook, of Concord, writes, " I have given special 
attention to cause, but have not discovered it." Dr. Boyn- 
ton gave " special attention" to the cause, but could not find 
it. "All used pure spring-water." Dr. Mooar investigated 
for the cause, but could find none. Dr. Chase writes that 
the past few years Peterborough is exempt from typhoid 
fever, why, he cannot see ; a few years ago there was a great 
deal, and the water-supply and the sanitary condition were 
the same then as now. Dr. Fleeman says he uses as good 
common sense as he can to find out the cause; he does not 
say, " This is the cause or that is the cause," and he adds, 
" It is quite doubtful if any of us know quite as much as 
we think we do in relation to what causes disease." 

In the Fourth Report of the New Hampshire Board, 
thirteen physicians who report on typhoid fever make no 

* Third Annual Report. 



2/2 VAGARIES OF SANITARY SCIENCE. 

mention of cause. Forty others say they could not trace it. 
Thirty-two ascribe the disease to polluted water, but do not 
say that in any case there was any examination of the water. 
Forty physicians give a variety of causes, — a tannery, a 
newly-plastered house, a privy, low vitality, atmospheric 
causes, swampy land, foul air, bad meat, contagion, pig-sty, 
low water, foul sink, decomposing vegetables, malaria, over- 
crowding, etc. Dr. Jenking had given special attention as 
to cause, but was forced to say that " the wind bloweth 
where it listeth ;" there were at least " no unsanitary' sur- 
roundings." Dr. Junkins investigated every case : " Investi- 
gation revealed nothing." Dr. Frost gave " special attention 
to probable cause," but could not find it. Dr. Flanders in- 
vestigated all cases and could not find the cause. Dr. Hill 
gave special attention to the cause and could not find it. 
Dr. Dearborn " investigated thoroughly for the cause, the 
sanitary surroundings being perfect." Dr. Parson gave 
special attention to the cause, but could not discover it. 
Dr. Lee made " strict inquiry," but no specific cause could 
be ascertained. Dr. Porter reports the sanitary condition 
good where his cases of typhoid occurred. 

For three or four years the New Hampshire Board of 
Health investigated typhoid fever with results similar to 
these. Dr. Hutchinson writes to the New Hampshire Board * 
that there is no typhoid fever in Milford. He says he has 
examined several wells, and he is certain that these, as well 
as many others, are ''polluted waters," but there is no typhoid 
fever. Dr. Jenkins writes as to the causes of typhoid fever, 
— " their name is Legion." Dr. Roberts never saw " a case 
where I thought contaminated water was the primary 
cause." 

In the Twelfth Report of the Michigan Board of Health 
forty-nine of the health-officers who are asked for the cause 

* Fifth Report. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 2/3 

of typhoid fever in that State make no reply. One hundred 
and nine stated that the cause was unknown. Five ascribed 
it to overwork; three, to decomposing vegetable matter; 
one, to animal decomposition ; one, to heat ; one, to hot and 
dry weather ; one, to exposure to wet and cold ; one, to a 
low temperature ; one, to living in a swamp ; one, to decay- 
ing slabs and sawdust, etc., etc. 

The Thirteenth Report of the Michigan Board of Health 
records typhoid fever occurring in two hundred localities 
during, the previous year. Forty-nine report the cause 
unknown. The board says there were " other indefinite 
replies." Among the causes named were overwork, ex- 
posure, impaired vitality, bad sanitation, etc. Twenty-three 
ascribed it to impure water, but none of them report any 
examination of the water. The Fourteenth Report of the 
Michigan Board of Health tells of typhoid fever in two 
hundred and ninety places the previous year. The board 
says, " The reports show that the health-officers, as a rule, 
do not yet succeed in tracing outbreaks of typhoid to their 
source." In one hundred and two replies nothing was 
said as to cause. Fifty said plainly that it was unknown. 
Various theories were advanced to account for special cases ; 
for example, impure water, low water in the wells, contagion, 
exposure, sleeping with a filthy person, overwork, a dead 
cow, a lumber-camp, hot, dry weather, exposure to wet and 
cold, privy-vaults, etc. 

The Board of Health of Ohio (Report, 1887-88) received 
one hundred and twenty-eight replies to questions as to the 
origin of typhoid fever. Thirty-nine say that nothing is 
known as to the cause. Forty-five say bad water, or " pos- 
sibly" bad water. Forty-five attribute it to direct exposure 
to other cases by nursing, or by living in the house with 
cases. One cause is given as travelling around with a 
threshing-machine; one, to sleeping in a loft over a 
stable. 



2/4 VAGARIES OF SANITARY SCIENCE. 

Dr. S. S. Turner,* of Fort Buford, says that he has seen 
typhoid fever on the prairies of Dakota, where the air is 
exceptionally pure ; and it is observed at military posts, where 
the sanitary conditions are " seemingly the best." " I have 
seen the same in commands living in tents upon the dry 
prairie, where the natural conditions are perfect and the privy- 
sinks remote from the camp." Dr. Stillman f writes that 
between July i, 1849, and January i, 1850, ninety thousand 
people arrived in California. It was roughly estimated that 
one-fifth of this number died within six months after arrival. 
Here was an entirely new country, with pure air, pure water, 
and pure soil. Dr. Stillman says that typhoid fever was very 
common and very destructive among these emigrants. 

The editor of the Medical Record {\%Z^, in commenting 
on the typhoid fever in New York that year, says, *' We do 
not remember when our city has been in a better condition as 
regards cleanliness than at present ;" yet there had been two 
hundred and forty-four cases of typhoid in August, 1883, 
against ninety-six in the same period of time the year 
before. 

• Dr. G. W. Robinson I says that in Trinidad, Colorado, a 
large number of cases of typhoid fever occurred in 1883. 
The people used water from three different sources, all 
pure ; thirty-five miles away from these cases he had others, 
where the water-supply gushed from the mountain-side; 
forty miles in another direction he attended typhoid fever, 
where the water was from a spring at the bottom of a canon. 
There were no other cases in the camp or neighborhood. 

Dr. Robinson believes that, to develop typhoid fever, it is 
not necessary to have the germs from a previous case. Dr. 
Patterson § says, " I have observed the disease in my field- 



* Medical Record, vol. xix. f Edinburgh Medical Journal. 

% Medical Record, vol. xxxi. 

\ California Board of Health Report, 1886. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 275 

service to affect men who were absent for months from 
permanent settlements, in the uninhabited mountain regions 
of Northern Idaho and Southeastern Nevada, where the 
presence of the specific germs of typhoid fever could hardly 
be suspected to exist." 

Dr. E. Stone * says it often happens that a physician is 
called to typhoid fever where the patient has not been away 
from home for weeks, and there has been no case in the 
neighborhood for years. He may find ground soaked with 
slops under the kitchen-window, or a bed of muck, or a 
running-over privy ; or he may not find these conditions. 
Of one thing he is sure, that his patient has not been poi- 
soned by the fecal discharges of other patients. 

Dr. Stone says that in the town where he has resided for 
twenty-six years quite a number of persons are employed 
in removing the contents of privies from Portland; their 
working-hours are constantly taken up in handling the dis- 
gusting material. Contrary to what might have been ex- 
pected, if human excrement contains the typhoid poison, he 
says, ** I have never yet had occasion to attend a solitary 
case of typhoid fever among this class of persons." Dr. 
Stone says the " excrement theory" of this disease " so 
essentially" conflicts with his experience of more than thirty- 
six years' practice that he is " compelled to reject it, not- 
withstanding the high authority by which it is sustained." 

Dr. Fr. Huef made a careful inquiry into the health 
of workers in night-soil at Rouen, and particularly as 
to their liability to typhoid fever. Sixteen are employed in 
emptying privies. Their ages vary from thirty to fifty years. 
These men have families of from eight to ten children, and 
one has eleven. Twenty-nine other men are employed in 
making poudrette of the faeces which the sixteen collect. 



* Transactions Maine Medical Society, 1877-79. 
f La Normandie Mhiicale, February i, 1892. 



276 VAGARIES OF SANITARY SCIENCE. 

The families of these men live in the depots where the pou- 
drette is made. Dr. Hue says that, except wounds, alcoholic 
excesses, and ophthalmia, there is a remarkable immunity 
from disease of any kind among all of these workmen and 
their families. Only one case of typhoid fever had ever 
happened among the workmen or their families ; this case 
occurred two years before, and was a young girl who at- 
tended a school. If the families of the poudrette-makers 
were one-half as large as those of the men who empty the 
vaults, there must be in Rouen not less than three hundred 
people exposed to these fasces. Dr. Hue says no hygienic 
precautions are taken, but they are "indemnified" from 
typhoid fever. La Normandie Medicate two weeks later 
reports eighty-three deaths from typhoid fever in Rouen in 
1 89 1, which indicate that there were about one thousand 
cases of the disease in that city in that year. Dr. Hue seems 
surprised at the result of his inquiry. He asks, May not 
the freedom from disease of this people be due to a kind of 
" slow vaccination ?" 

Dr. Bramlett * says that he has studied for many years 
the causation of typhoid fever in a mountainous country, 
supplied with pure spring-water, where there are neither 
ponds nor marshes. The elevation is twenty-five hundred 
feet above the sea. The cases that he narrates could not be 
traced to water, nor filth, nor " importation." " From 
whence," he asks, " did the contagion come ? Obviously, I 
think, from the bodies of those having the disease." Dr. 
Bramlett is persuaded that it arises spontaneously, and that 
it is contagious. 

Professor Cabell f concludes that "there are yet many 
unsolved mysteries" with regard to its development and 
spread ; and it is to be regretted that the exclusive ascription 



* Virginia Medical Monthly, 1 877. 
t Etiology of Typhoid Fever, 1877. 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 277 

to putrescent matter, contaminating air or water, should 
divert attention from other less easily assigned, but possibly 
equally influential, agencies. 

Dr. Hicks,* of Michigan, says that he has practised 
medicine in a new country, in a community which had 
sprung up in six months. " Two or three hundred people 
built their houses, and typhoid fever broke out before there 
was any kind of sewage. We had it on new farms, and we 
had it every year more or less ; and he adds, ^* If the cause 
of typhoid is known, / don't know it." 

We have seen on a previous page (p. 98) the condition of 
New Orleans regarding its exposure to fecal emanations. 
The people here, Dr. Holt says, live on a dung-heap, and 
have a privy in common. For the four years ending 1889 
the number of deaths from typhoid fever in that city was 
forty-six, forty-one, thirty-four, and thirty-five. The city of 
Washington, with a population less by twelve thousand than 
New Orleans, furnished during the same years one hundred 
and twenty-eight, one hundred and sixteen, one hundred 
and sixty-eight, and one hundred and seventy deaths from 
the same disease. " But," says the sanitarian, " New Orleans 
drinks pure rain-water from cisterns, and therefore has im- 
munity from typhoid fever. The Louisiana Board of Health 
Report for 1886-87, p. 169, says that for a limited time, 
almost yearly, New Orleans suffers a water-famine. " The 
roofs and gutters carrying this water accumulate quantities 
of impurities, such as dust, highly charged with organic 
matter; and these with each rain are washed into the 
cisterns." 

Assistant Surgeon Charles Smart,t in his report on the 
water-supply of New Orleans, says the rain-water carries 
into the cisterns soot and condensed ammoniacal vapors ; an 



* Proceedings American Public Health Association, vol. xiv. 
f National Board of Health Report, 18S0. 
24 



2^S VAGARIES OF SANITARY SCIENCE. 

infinity of debris, organic and inorganic, together with more 
massive fragments, as of dead insects and decaying leaves, 
all of which forms a soft, black, pultaceous sediment, ren- 
dered impure by being stirred up by every succeeding rain- 
fall ; and the water is unfit for use after such rain-fall. Of a 
sediment from one cistern, one hundred parts yielded fifty- 
four parts of albuminoid ammonia. In October, 1 891, Dr. 
Metz, chemist of the Louisiana Board of Health, pronounces 
the water of New Orleans as altogether bad. More than 
half of the samples which he examined were unfit for use, 
many of them being similar to " stagnant swamp-water." 

This is just such water as has caused typhoid fever thou- 
sands of times, according to the sanitarians. Would Wash- 
ington change its bounteous supply of the torrents of the 
Potomac for the scanty quantity of the foul water that the 
Louisiana Board of Health, Dr. Smart, and Dr. Metz say is 
supplied to New Orleans. 

On account of the importance of this subject the author 
makes no excuse for prohxity in discussing it. 

In surveying the evidence which the sanitarians them- 
selves have collected, one is struck with astonishment at the 
agreement of the working members of the medical profession 
that the cause of typhoid fever is not ascertained. The 
silence of the hundreds of physicians in Massachusetts, New 
Hampshire, Connecticut, Ohio, and Michigan, when appealed 
to for the cause, is as full of meaning as the outspoken opin- 
ion of those who say that the cause is unknown. It cannot 
be that these hundreds of physicians, who are daily rushing 
about the cities, and jolting over the hills and plains of those 
States, watching the rise, progress, and termination of cases 
of this disease under all circumstances, know the cause and 
will not divulge it. 

The evidence here exhibited shows that the acutest ob- 
servers and profoundest intellects of the medical profession 
have recorded their observations of this omnipresent fever, 



FILTH AND FECAL DISEASES— TYPHOID FEVER. 2/9 

on a colossal scale, over three continents and the islands of 
the sea. Is it not conclusive that, in respect to our knowl- 
edge of its etiology, we are where we were sixty years ago, 
when Louis and Chomel described the disease to us, and 
when they declared that, except age, recent residence, and 
perhaps sex, its causes were wrapped in the deepest ob- 
scurity ? 

The doctrine is taught in the schools that the typhoid 
dejecta are harmless when passed, but that under exposure 
to the air, or in the presence of filth, they develop a poison 
which is capable of giving rise to this fever. This dogma is 
accepted by so many truly learned, as well as renowned, 
medical men, that to escape the charge of disrespect, we will 
not openly combat it. We would, however, ask if there is 
any proof that the typhoid stools suffer any such change, 
either in filth or on exposure to air. 

It seems as if this hypothesis had been evolved out of the 
previous one, — that typhoid fever is a pythogenic disease, 
or that the telling of one untruth had led to the telling of 
another. Typhoid fever was born of putridity ; but it was 
shown that, in thousands of cases, exposure directly to 
typhoid excreta did not induce the disease (Murchison). 
Instead of questioning its pythogenic nature, and seeking 
elsewhere for its cause, it was easier to formulate a new 
hypothesis, which could be mortised into the original theory, 
— namely, that these excreta, so innocent when passed, ac- 
quired by time and change the power to spread the disease. 
Again, it was shown in the cruel epidemics at Croydon in 
1876, at Paris in 1883, at Berhn in 1889, and in ordinary 
seasons at a great many other places where typhoid excreta 
were poured upon sewage farms, that those who were most 
exposed to the fecal matter did not take the disease. There- 
fore still another theory was necessary, — that the typhoid 
dejecta, in their transit through the sewer of, say, from twelve 
to twenty-four hours, suffered a relapse, but reacquired their 



280 VAGARIES OF SANITARY SCIENCE. 

innocence ; that they not only found their depravity in the 
sewers, but their purgatory also. 

The Massachusetts Board of Health * say the typhoid 
poison is destructible readily on free exposure to the air, as 
was shown at Croydon, where fourteen hundred cases oc- 
curred, and a great portion of the dejecta, not disinfected, 
passed into the sewers and was spread over an irrigated farm, 
to which large numbers were exposed. " The water of the 
surface-wells in that vicinity, really the purified sewer con- 
tents, constituted almost the sole supply for drinking and 
other domestic purposes for many people, and in no case 
was the fever propagated in that vicinity." 

If there be no proof that such changes take place in the 
typhoid stools, are we not justified in saying that there is 
nothing in analogy to warrant the opinion that time or place 
can so transmute them ? Is the poison of the cobra, or that 
of the rattlesnake, more virulent after it has become decom- 
posed ? When we vaccinate a child, do we seek for virus 
that has undergone a change and become something else 
than vaccine ? or are we particular that it shall be as pure as 
possible ? If it has undergone '* certain changes," do we not 
know that it is inert ? 



CHAPTER XIII. 

Yellow Fever. 

The belief in the filth and fecal origin of this disease is 
firmly established in the minds of the sanitarians. It is 
unnecessary to go into its history here, any more than to 
say that, as it has disappeared from many localities in our 

*i879. 



YELLOW FEVER, 28l 

own country where it formerly prevailed, the opinion is 
pretty firmly grounded, in the minds of most medical men, 
that it is an imported disease. Though it is said that now 
its home is in the West India Islands, it was not recognized 
there until the middle of the seventeenth century. Neither 
Columbus * nor any of the early Spanish adventurers men- 
tion it. At the close of the last century and the beginning 
of the present it was not uncommon as an epidemic in the 
Northern States ; and some acute observers, who made 
special investigations at that time, were persuaded that it 
was indigenous to the seaboard States in general. 

Noah Webster made a careful inquiry into the causes of 
the epidemics of 1793 and 1794 in New York and Philadel- 
phia. He became convinced of the fallacy of the opinion 
that it originated from abroad ; and he thought the evidence 
was complete that yellow fever could arise in this country 
between the parallels of 41 and 44 north latitude. He found 
repeatedly that the stories of its source from infected cloth- 
ing and from intercourse with ships were idle tales of the 
interested or the ignorant. On the other hand, the evidence 
of its origin in New York, Baltimore, Charlestown, Boston, 
and other places was to him clear and unquestionable. He 
says,t " Nothing is more common than for yellow fever to 
be imported into the West Indies in vessels directly from the 
United States." Mr. Webster thought there was not much 
doubt that it was a pestilence among the Indians before the 
landing of the Pilgrims. He did not believe that it was 
contagious. 

In 1800, Dr. Ramsay t wrote to Dr. Miller, of New York, 
" The disputes about the origin of yellow fever, which have 
agitated the Northern States, have never existed in Charles- 
ton. There is but one opinion among the physicians and 

* Tytler, " Yellow Fever," 1799. f Vol. ii., p. 447. 

X Edinburgh Aledical and Surgical Journal, vo\. Ixxviii. 

24* 



282 VAGARIES OF SANITARY SCIENCE. 

inhabitants, and that is that the disease was neither imported 
nor contagious." 

In 1804, Dr. Stubbins Pfirth published a thesis to prove 
that yellow fever not only had its origin here, but that it was 
non-contagious ; and he records his experiments. Previous 
to the Philadelphia epidemic, he believed that the disease 
was imported and communicated from one patient to an- 
other ; but he was led to change his mind. He fed a dog 
with bread soaked in black-vomit ; in three days he became 
so fond of it that he took the black-vomit plain. It had no 
effect on the animal's health. He fed the same to a cat, 
with no ill results. He injected black-vomit into the cellular 
tissue of a dog ; the incision healed at once, without doing 
him any harm. He injected the vomit into the jugular vein 
of a dog, which caused death in ten minutes. He then in- 
jected water into the jugular vein of a dog; the animal died 
in ten minutes. And now, to show how depraved a doctor 
can become when he devotes himself to science, he inocu- 
lated himself more than twenty times with black-vomit ; no 
ill effects followed. He put the same into his eye, and no 
harm ensued. Not content with this, he evaporated black- 
vomit over a fire, inhaled the steam, made the residue into 
pills, and ate them. He then drank a half- ounce of black- 
vomit, immediately after his patient had ejected it, and 
repeated these trials a number of times without any ill 
effects. He was fully convinced by these experiments that 
yellow fever was not contagious, 

Dr. Jackson and a majority of the medical profession in 
Philadelphia believed that the epidemic of 1820 had its 
origin not from abroad, but in the city. The outbreak of 
1853 in Philadelphia was ascribed by many physicians to a 
local origin; and as late as 1879, Dr. Burroughs* sharply 
reviews the opinion of the commission which pronounced 

* Virginia Medical Journal. 



YELLOW FEVER. 283 

yellow fever an exotic disease. Although for two centuries 
there had been frequent communication with and importa- 
tion of merchandise from localities infected with this disease, 
it did not appear in Brazil * until 1849. In 1859 there died 
in Rio Janeiro four thousand one hundred and sixty persons 
of yellow fever. In 1855 and 1856, and for six years end- 
ing 1 868, there were no deaths in that city from the disease. 
Since then the city has never been free from yellow fever. 

The yellow fever in New York in 1794 was pronounced 
by the Rev. Dr. Dickenson f not a scourge from the hand 
of the Lord, nor an imported evil, but " the offspring of 
their own domestic filth." 

Dr. Cartwright attributed the fever in Mississippi to a 
mass of putrid bacon. Dr. Caldwell said that it seemed 
fairly referable to some putrid fish, and he had seen it caused 
by putrid oysters and hides. 

It was said that the yellow fever at Pensacola in 1822 was 
caused by the importation of putrid fish ; but Dr. Merrill 
showed that one hundred of the United States troops were 
exposed in the most uncomfortable quarters, in the midst of 
a whole cargo of this fish, for four weeks, and not a case 
occurred among them until three weeks after it was re- 
moved. At the same time, however, a battalion of infantry, 
stationed a mile distant from the putrid fish, in a dry, airy 
situation, was sorely afflicted with violent bilious fever. 
The sailors, too, who had been living on board for a number 
of months, close to the fish, arrived in good health, and 
suffered only in common with the other inhabitants at Pen- 
sacola, three or four weeks later. In Newbern the fever 
was ascribed to stable-manure and street-sweepings that 
were thrown into the water to extend a dock. 

To prove the filth and fecal origin of yellow fever, the 
sanitarians call our attention to the exploits of General 

* Reference Hand-book Medical Science. f La Roche. 



284 



VAGARIES OF SANITARY SCIENCE. 



Butler in New Orleans, who, they loudly declare, " stamped 
out" yellow fever in that city in 1862 by removing the filth. 
To those who listen merely to the assertions of the sanita- 
rians and of the general himself, who has told exactly how 
he did it, it appears that, either by revelation or by intuition, 
he actually possessed some sanitary prevision not vouch- 
safed to the rest of mankind. Dr. Chaille * says he will 
not contest the general's claims as a warrior, a Democrat, a 
Republican, and, again, a Democratic statesman; but he 
protests against the validity of his fame as a great sani- 
tarian. Dr. Chaille says that in 1861, when General Lovell 
was in command in New Orleans, many of the civil and 
military inhabitants were unacclimated ; yet no death oc- 
curred from yellow fever, and, as far as is known, there 
was no case of the disease in the city during that year. Dr. 
Chaille cannot understand why General Butler should be 
honored by men of science as an eminent sanitarian, while 
the better sanitary results of General Lovell are ignored 
altogether. 

The fact is that in both years there was no opportunity 
for the disease to arise from imported cases. But, as is 
shown in the following table, there have been many other 
years when New Orleans has been nearly as exempt as in 
1861-62: 



Year. Number of Deaths, 

183I 2 

1836 5 

1840 3 

1845 2 

1851 17 

i860 15 

1865 I 

1877 I 

1882 2 



Year. Number of Deaths. 

1833 1000 

1837 1300 

184I 1325 

1847 2804 

1853 7849 

1854 2425 

1855 . 2670 

1867 3107 

1878 . 4056 



■^ Sanitarian, vol. x. 



YELLOW FEVER. 285 

Is it logical to assume that the fecal matter in New Or- 
leans caused only one death from yellow fever in 1877, and 
suddenly became so active that the next year it caused four 
thousand and fifty-six deaths; or that in 185 1 it caused 
seventeen deaths, and two years later became so operative 
as to destroy seven thousand eight hundred and forty-nine 
people ? 

Dr. Dowler,* of New Orleans, declared that yellow fever 
had never happened in the parish prison in that city, and 
concludes, " There is, if we may reason from what is known, 
but one certain method of escaping yellow fever in New 
Orleans, — incarceration." The disgustingly filthy condition 
of this prison had been often admitted to be a reproach to 
the city ; and that, too, by its own people. And now comes 
the most brilliant of all sanitary paradoxes. We read in the 
Louisiana Board of Health Report (i 880-1 883) that the 
exemption of the parish prison from yellow fever at New 
Orleans has been due to isolation, and to " the exhalations 
of ammonia from the excrement of the bats which inhabit 
the garret of the building in vast numbers ; and also from 
the urine of the prisoners!" Between the years 1855 and 
1870 the admissions to this prison averaged from five thou- 
sand to seven thousand annually. Why the excrementa of 
bats and men should prevent yellow fever in the parish 
prison of New Orleans, and be competent to cause an 
epidemic of the same disease just outside the walls, will 
probably always remain one of the mysteries of Sanitary 
Science. 

But, wherever it broke out, the bad sanitation of the place 
was held up to us. The keen-eyed sanitarian could find 
somewhere a privy, a cesspool, a stable, some kitchen refuse, 
or some decayed wood ; or else he would learn that some- 
body had been stirring the filth in the saturated soil ; and 

^ La Roche. 



286 VAGARIES OF SANITARY SCIENCE. 

he called the discovery of any of these things an investi- 
gation. 

In 1870 the disease visited New York harbor. Some ships 
arrived that year from infected ports, and were moored at 
the Brooklyn docks. The man unversed in Sanitary Science, 
whose mind has not yet quite grasped its inflexible laws, — 
that two and two make five, — will say that the disease ap- 
peared, of course, in the slips of the rotting wharves, and 
among the filthy purlieus, streets, and lanes, which border 
on the water. Not at all. Those places were untouched by 
it. It broke out on the rigidly-policed and cleanly-kept 
military post of Governor's Island. 

The shrewd sanitarian looks for the cause, finds it, and 
records it on page 337 of the New York City Board of 
Health Report for 1870. We are solemnly told that during 
ebb-tide there was a current setting from the docks where 
the infected vessels lay towards Governor's Island ; and 
things might have been thrown overboard from them and 
lodged on the beach. In this way we have the yellow fever 
of 1870 accounted for at that island, which General Mc- 
Dowell said was exceptionally clean; and which. Assistant 
Surgeon Guild said, had a drainage " so perfect that pools 
of stagnant water are never known on the island." But 
why the people who were continually going from the in- 
fected ships to the shore, and landing cargoes, and coming 
in contact with the inhabitants, did not communicate the 
disease to the crowded and filthy localities in Brooklyn ; or 
how the things which were perhaps (for no proof was ofr 
fered) thrown overboard, and which perhaps touched Gov- 
ernor's Island, could gather venom in their transit through 
East River, was never explained. 

- Though this idea of the filth-origin of the disease was 
common among those who made no investigation, it was 
forcibly contested by many able observers, who sustained 
their arguments by incontrovertible facts. Indeed, the author 



YELLOW FEVER. 28/ 

has found no instance where an epidemic of yellow fever has 
been investigated with care in which the proof was not conclu- 
sive that it had no relation to filth or fecal deposits. Dr. 
Bancroft,* in 1810, denied that filth had anything to do with 
the production of yellow fever. Dr. Revere f showed con- 
clusively that putridity had nothing to do with causing it in 
Baltimore. La Roche quotes Deveze, who says it has 
always been observed that curriers, tanners, soap-boilers, 
candle-makers, and, in general, all who breathe an unwhole- 
some atmosphere, are not liable to the disease. Dr. Rush 
noticed that it rarely attacked butchers, and that scavengers 
escaped it entirely. La Roche concludes, from the facts that 
yellow fever is often generated where there is no animal 
decomposition, and that dissecting-rooms, slaughter-houses, 
knackers' yards, cemeteries, and other places where putridity 
is at its height are recognized as innocuous, that this fever 
does not result from animal decomposition. SavaresyJ 
{Jievre jaune) ascribed the cause of the fever to the air viti- 
ated by a noxious and unknown influence. 

The subject received more serious scientific investigation 
after the epidemic of 1878. It appeared at Grenada, Missis- 
sippi, which stands on an elevated plateau, and is so situated 
that every rain washes the streets and gutters clean. The 
house where it first appeared "was in good sanitary condi- 
tion." Yet only five white persons who remained in the town 
escaped the disease. Colonel T. S. Hardee, United States 
Engineers, said, " This recent epidemic of yellow fever (in 
New Orleans, 1878) was more virulent and prevalent, and to a 
greater extent, in parts of the city that were entirely paved 
and well drained, than in those parts where the streets were 
filthy, and where the drainage was imperfect." Major Wal- 
thall, § whose experience as a nurse was greater than that 



* Yellow Fever. f La Roche. J 1809. 

§ Proceedings American Public Health Association, 1S79. 



288 VAGARIES OF SANITARY SCIENCE. 

of any oth^r man in the country, did not believe the sanitary 
condition of a city had anything to do with the spread of 
yellow fever. He had " seen it most virulent in the cleanest 
and purest sections, while the dirty and filthy portions were 
comparatively exempt." Judge Clapp said that Holly 
Springs was " proverbial for its cleanliness and beauty ; 
located on a high, sandy ridge ; yet the town was decimated 
by the scourge." 

Dr. Hargis, of Pensacola, said that the idea that the fever 
was caused by filth on land was a delusion. Dr. Cockrane,* 
in a special report on yellow fever in Grenada, Mississippi, 
in 1878, says that the town was in good sanitary condition. 
He lays down the proposition that it is caused by a specific 
poison ; that this poison is not in any way the product of 
ordinary filth, and has no necessary association with filth as 
such. In Baton Rouge it was a noteworthy fact that " the 
portions of the town where the worst sanitary condition was 
observed were the least infected, and suffered least." Dr. 
Campbell declared that if filth were piled to the second- 
story windows, we would not have yellow fever, unless it 
was introduced. 

The delegation from the Mississippi Board of Health f 
says, " The abundant experience we have just had leads us 
to believe that, while disinfectants, cleanliness, good drainage, 
etc., have their merits in the prevention of some other dis- 
eases, they are utterly powerless to prevent yellow fewer. 
Localities that were in the best sanitary condition were 
visited by the disease, which spread rapidly, and was as fatal 
as in other localities." 

Dr. Herrick, of New Orleans, asks, " If its causes are in 
sanitary conditions, why does not the fever show a decided 
preference for foul localities ?" Major Walthall said that in 



* Sanitarian^ iZ"]^. 

f Proceedings American Public Health Association, vol. i. 



YELLOW FEVEF. 289 

1853 the disease broke out in New Orleans in June; there- 
fore the people of Mobile had ample warning. Cleansing 
and fumigation were thoroughly carried on ; but it arrived 
there on the 12th of August, and swept the city. He added, 
" Where yellow fever has prevailed the worst has been in the 
cleanest places ;" and, comparing the condition of a place in 
the year in which yellow fever raged with its condition in 
other years, " It has been found to be much cleaner at the 
time yellow fever became epidemic than at any other time. 
The unhealthy districts of a city, as regards ordinary years 
and circumstances, are the most exempt from yellow fever. 
. . . The city of Pensacola is remarkably clean. It is built 
on a bed of clean sand, and has no filth ; yet yellow fever 
has prevailed there in its severest types." Dr. Selden, of 
Norfolk, said that imperfect sewerage, upturned earth, etc., 
had never been the cause of yellow fever in Norfolk. 

The Committee of the Public Health Association, con- 
sisting of Dr. Sternberg, Dr. Choppin, and others, who 
examined the evidence collected respecting the epidemic in 
the towns on the Mississippi, say, after a hasty examination, 
" The committee cannot find there are any uniform local con- 
ditions. Yellow fever has prevailed in cleanly places and in 
filthy places, in high places and in low places, among the 
rich and the poor." Dr. Sims, of Chattanooga, said that 
filth was not the cause in that city. Dr. Harrison had vis- 
ited many localities in the South during the epidemic of 
1878. ** I found it was not in the most filthy parts of a city 
that yellow fever originated. It was not in the most filthy 
parts where it was most malignant." 

Dr. Atkinson, of the Tennessee Board of Health, said, 
" If the utterances of members of this association shall go 
out to the world, assuming definite shape, as they have been 
advanced and expressed here, that the filthiness of a com- 
munity has no influence in the spread of yellow fever, with- 
out challenge, it will paralyze all sanitary efTort." Dr. 
N t 25 



290 VAGARIES OF SANITARY SCIENCE. 

Atkinson's language was energetic, and his rhetoric superb. 
He yielded the floor to Dr. Bell, who remarked on the over- 
flow of lands, and added with some pathos that he should 
be very sorry " that anybody could believe that with filth 
they might be indiflerent." He said, " Let it never go 
abroad that filth is to be indulged in because in some one 
place it did not happen to be heated enough to develop 
disease." Dr. Atkinson and Dr. Bell omitted to tender any 
facts to controvert the reports of the two committees, or the 
unimpeachable . testimony of the individuals that filth or 
fecal matter had no relation to the rise and spread of yellow 
fever. 

Dr. Thornton reported that in 1879* the yellow fever 
broke out anew in Memphis ; there were fifteen hundred and 
thirty-two cases and four hundred and eighty-five deaths 
that year. He says there was not a street in the city in an 
unsanitary condition. " The city was as cleanly as any city 
in the country of the same size ; perhaps more so." 

Dr. Heineman,t long a resident of Vera Cruz, says that 
for twelve years Vera Cruz has had a good water-supply ; 
the baths are well attended, the streets are the best-policed 
in Mexico ; yet in those twelve years it has had three fright- 
ful epidemics of yellow fever. He adds, " It therefore 
evidently follows that filth, per se, has nothing to do with 
yellow fever." 

Surgeon Clements, U.S.A., on the epidemic in New Or- 
leans in 1867, says that scrupulous precautions were taken 
with fecal discharges. He learned " no fact which lent 
support to the suggestion that, like cholera, it might be 
considered a fecal disease." 

Dr. Nott, who, on account of long experience with yellow 
fever at the South, was appointed to investigate the epidemic 



* Proceedings American Public Health Association, 1879. 
f Report National Board of Health, 1880. 



YELLOW FEVER. 29 1 

in New York harbor in 1870, said in his report that this 
disease may traverse a half-dozen States in an epidemic, 
" showing the same virulence on the arid, clean hill-top as in 
the filthy alleys of a city." 

Dr. Joseph Jones,* of New Orleans, says, " Yellow fever 
may prevail in one or more cities, and at the same time be 
entirely absent from other cities in the same zone and sub- 
jected to very nearly the same hygienic conditions. The 
mere absence of yellow fever from a particular city proves 
nothing as to the mere sanitary condition and measures of 
the city enjoying the immunity." 

The National Board of Health f says that New Orleans 
has a soil supersaturated with filth; "yet since 1858 there 
has been a very marked diminution in frequency of yellow- 
fever epidemics, though the filth has increased annually. 
The board adds, " If yellow fever be a fecal disease, it is 
difficult to understand why an increase of fecal saturation 
and deposits should be accompanied with a decrease of the 
disease." 

The epidemic in Florida in 1888 showed no preference for 
filthy localities. Jacksonville, where it raged the worst, was 
a clean city. It was far superior, in respect of cleanliness, to 
most other places of the same size in the country. The 
fever prevailed in Fernandina ; but Dr. Starbuck says % that 
the sanitary condition of Fernandina, before the epidemic 
appeared in Florida, was excellent. " Still, when the fever 
broke out at Jacksonville, every lot and street in Fernandina 
was thoroughly cleaned and disinfected with lime, sulphur, 
iron, and pyroligneous acid." The city was never cleaner 
or more healthy ; yet by the 20th of September, five weeks 
after it attacked Jacksonville, it was raging in Fernandina." 
The disease was severe at Gainesville. Assistant Surgeon 



* Quain, Diet. f 1880. 

X Report Supervising Surgeon-General Marine Hospitals, 1S89. 



292 VAGARIES OF SANITARY SCIENCE. 

Martin * reports " the sanitary condition of the city excellent, 
and the general health exceptionally good." Mr. Joseph 
Voyle, C. E.,t says that in Gainesville " the infection began 
in the cleanest places in the city, in the ordinary meaning 
of cleanliness." The deduction which he makes from the 
epidemic is that the conditions which favor the rise and 
progress of yellow fever are beyond human control ; " pre- 
cautions may mitigate, they cannot obviate" them. 



CHAPTER XIV. 

Cholera. 

Of all the so-called zymotic diseases, none has been so 
positively imputed to filth and fecal deposits as cholera. After 
this theory was adopted, numberless diverse and confusing 
hypotheses were brought forward to account for the action 
of filth in producing the disease. Not one of these hypoth- 
eses had any value, for none was founded on experiment or 
scientific observation. It was not very difficult for ingenious 
speculatists to say that it was caused by specific organic 
matter, in which was hidden the active principle of the 
disease which was called cholerine ; or to say that emanations 
arose from fecal discharges which, under " favoring condi- 
tions," gave rise to " the choleriginous principle ;" or to tell 
us that it arose from want of ozone ; or for a great many 
others to talk of fecal deposits spreading the disease by 
undergoing " certain decompositions" under " certain cir- 
cumstances." After we had read all these theories and 



* Report Supervising Surgeon-General Marine Hospitals, 1889. 
\ Proceedings Quarantine Conference, 1889. 



CHOLERA. 293 

many more like them, we were no wiser about the cause of 
cholera than we were before they were written. 

Though this disease was described two hundred and fifty 
years ago, it did not appear in Europe until the third decade 
of the present century. For two hundred years it had 
ravaged Burmah, Siam, Cochin-China, Malacca, Sumatra, 
and Java ; and though intercourse was common and frequent 
between those countries and the Western nations during this 
period, with every opportunity for the disease to be trans- 
ported by people and merchandise, it did not transfer itself 
from those localities until nearly 1820, when, through some 
unknown cause, it slowly commenced its travels westward. 

In 1 8 19 it had reached Bombay; it did not touch the 
Mediterranean shores until 1823 ; it then halted on the con- 
fines of Europe for a few years. In 1830 it was on the 
Caspian Sea, and reached Moscow; in June, 1831, it arrived 
at St. Petersburg ; it was at Vienna in August, and in Sep- 
tember of the same year it reached Berlin. In October it 
appeared in England; in January, 1832, it was in Edin- 
burgh ; at London in February, and at Paris in March. It 
then crossed the Atlantic. Early in June it broke out in 
Quebec; it was at Montreal on the 14th; in July it had 
reached Albany and New York. From thence it swept 
through the South and West, to the Gulf of Mexico and 
Yucatan. 

It was declared that it came to Quebec by an emigrant- 
vessel, but there were physicians in that city who asserted 
that they had cholera-patients before the arrival of the ship. 
The first case in New York City was on the corner of Gold 
and Franklin Streets, on the 25th of July. Two days after, 
an aged woman, who had been in Bellevue Hospital for 
three years, and who had had no communication with persons 
outside, took the disease. Other cases followed in different 
parts of the city, until the epidemic became general ; but 
there is no record that the earliest cases were connected 

25* 



294 VAGARIES OF SANITARY SCIENCE. 

with each other or with any newly-arrived emigrant- 
vessel. 

This epidemic did not entirely cease in the South and 
West of the United States until 1836, and it lingered much 
longer about the villages and small towns than in the more 
crowded cities. Dr. Whitney says, " In no section of the 
States have greater numbers, compared with the whole pop- 
ulation, fallen victim to it than in the fertile and sparsely- 
settled prairies of the South and West." 

The cause of cholera, as it was manifested in this wide- 
spread epidemic, was the subject of an exhaustive investiga- 
tion in France, undertaken by a commission nominated by 
the French government. It was published by order of that 
government in 1834. The commission * say of cholera, " It 
comes without any known cause ; it disappears without any 
real reason." Previous to its arrival, the Board of Health in 
Paris inspected all insalubrious places and houses ; closed up 
four hundred and two of the latter in a single district, on 
account of bad wells and privies ; supervised all markets, 
theatres, coffee-houses, and cemeteries ; all filth was removed, 
and chlorine was poured into the ditches and streets. The 
people were congratulated on the good sanitary condition 
of the city, compared with previous times. Eighteen days 
after the first appearance of the disease there had been 
between twelve thousand and thirteen thousand cases, and 
more than seven thousand deaths. The streets that suffered 
most were generally where the population was most dense, 
and composed of the poorer classes. 

The commission says, " Investigation has confirmed the 
fact that everywhere the cholera sported with human pro-, 
visions and gave the lie to opinions the most generally 
received, and rendered questionable what seemed to be most 
firmly accredited. It was often in the most salubrious and 

* Rapport sur la Marche et les EfFets du Cholera, Paris, 1832. 



CHOLERA. 295 

least exposed villages that its ravage was most severe, while 
it left scarcely a trace of its passage in localities which were 
always considered as sources of infection and disease. . . . 
It is difficult to have an exact idea of the filthiness of Gen- 
tilly. . . . Shut up in a narrow defile, it is traversed by the 
Bievre, whose waters move sluggishly, mixed with the im- 
purities of a multitude of wash-houses, wool-cleaning estab- 
lishments, dye-houses, chemical laboratories, and other 
factories ; . . . smelting-houses of grease taken from bones ; 
but, above all, cloth-dressing establishments, so many in 
number that the spectator might be led to believe that all 
the followers of that business had fixed their habitations in 
the same village. ... A great many of the wells of Grand 
Gentilly are so saturated by infiltration from the sewers of 
Bicetre that the water cannot be used, even for the commonest 
household purposes." At Clichy insalubrity is at its highest 
point; the ponds and ditches in the fields surrounded by 
houses are full of soap and lye. " The streets themselves 
are common sewers, and each step one takes is amid 
stagnant waters." Yet the mortality in these two villages 
was eleven for Clichy and twelve for Gentilly per thousand ; 
"while many communes in which the sanitary committee 
found nothing to blame lost thirty-five, thirty-seven, forty, 
fifty, and fifty-five per thousand." ..." Can the mortality 
presented by Clichy be attributed to its being sheltered 
against the northeast wind, and^ above all, to the ammoniacal 
exhalations V 

The loss of the civil population in Paris was 21.8 per 
thousand. At St. Denis was reported an unhealthy estab- 
lishment, where skin-dressing was carried on, and where 
twenty cows were kept. Urine and water had no outlet ; 
they ran into a cesspool and were pumped out into the 
highway, corrupting the air for a mile with the stench. 
" That house had but one cholera-patient, and nobody in 
adjacent buildings was affected, though one was a school 



296 VAGARIES OF SANITARY SCIENCE. 

which had eighty boarders and forty day-scholars." The 
disease did not rage among butchers, though cow-houses, 
sheep-folds, and slaughter-houses were plenty. Bercy 
exhales noxious and repulsive effluvia ; yet there was " but 
one case of cholera within its limits." The epidemic spared 
the village known as Breche aux Loups and the Rue de la 
Lancette, which were constantly overflowed by the filth of 
laundries, so that the houses were surrounded by pools and 
the highways rendered impracticable. *' Nothing could 
surpass the stench of that sink when first visited." 

In the village of Colombe was a glue-factory, where the 
basins presented a large surface of fetid exhalations. " Its 
immediate vicinity proved less unhealthy than the rest of 
the village." The same remarks apply to the communes of 
La Villette and Crenelle. The villages Pantin, St. Germain- 
des-Pres, and Belleville, which received the fetid emanations 
from the voirie of Montfaugon, are placed in the category of 
those that suffered least, — seventeen, eighteen, and nineteen 
per thousand. 

Out of one hundred and fifty-four workmen who were 
employed in making poudrette from the choleraic faeces 
brought from Paris, only one died of cholera. During the 
epidemic the inhabitants residing nearest places where the 
animal manures were kept were not even attacked. The 
occupation of these people might warrant the belief that 
habit protected them ; but those who lived and worked all 
around the voirie were nearly as exempt as those employed 
in it. The military posts in and about the city which were 
most carefully poHced and cleanly maintained suffered a 
greater mortality than Paris at large, — namely, more than 
twenty-five per thousand. 

The disease remained quiet in its home in the East until 
1848, when from some unknown cause, and without any 
change in the condition of the people of Europe or of 
America to invite it, it again started westward by about the 



CHOLERA, 297 

same route as before, and raged on the Continent and in 
Great Britain with greater severity than in 1832. 

Dr. Sutherland, of the Board of Health, made a report to 
Parliament on the cholera of 1849 in Great Britain. The 
faith in the dirt-origin of all infectious diseases was so firmly- 
grounded in England at that time that he would have been 
a bold man indeed who had run counter to it. Wherever 
the disease appeared, Dr. Sutherland was able to find a 
privy, or cesspool, or garbage, or a pile of manure, or drunk- 
enness with filth, or a pump that somebody had complained 
of, although maybe the people had been drinking its water 
for a century without experiencing the sHghtest harm. A 
graveyard caused it in Bristol, a mud-flat in Cardiff. It 
raged in Inverness ; here the town was clean, and now the 
subsoil water was accused. But why the subsoil water 
should be so particularly deadly during this hot and dry 
summer was not explained. Overcrowded cemeteries caused 
the disease in London. 

This report has no scientific value, in that it omits all 
account of those places in Great Britain which had no 
cholera, or only a few cases, but which were just as obnox- 
ious to it, by reason of exposure to precisely those influences 
which were said to be its cause where it did prevail. Bir- 
mingham was one of the filthiest towns in the kingdom ; 
but this city was remarkably free from cholera, both in 1832 
and in 1849. Though it raged at Billston,ten miles distant, 
and though there was constant communication between the 
two places, only thirty-one cases were reported at Birming- 
ham in 1832. This city also escaped the epidemic of 1865. 
The Royal College of Physicians were not willing to accept 
Dr. Sutherland's report as final, and they appointed a commit- 
tee to investigate the epidemic of 1849. The committee's 
report contrasts with that of Dr. Sutherland, but corresponds 
with that of the French commission on the cholera of 1832. 
They say (through Dr. Baly) that the epidemic fell severely 



298. VAGARIES OF SANITARY SCIENCE. 

on comparatively few localities. Densely-populated regions 
on rivers and sea-coast suffered most. Three large seaports, 
however, almost entirely escaped. Many large inland towns 
in a defective sanitary condition had but few deaths. " The 
sanitary condition of many of these towns would afford no 
reason for their escaping." " Of the multitude of smaller 
towns that escaped, very many were at least as insalubrious 
as places of the same size which were severely attacked." 
While cholera is generally associated with poverty, over- 
crowding, deficient ventilation, imperfect drainage, want of 
cleanliness, etc., " it is equally certain that in some public 
institutions, and even in some private houses, except where 
perhaps there is want of ventilation, the conditions of insa- 
lubrity did not exist, the disease caused a large mortality in 
proportion to the number exposed," while " some of the 
localities which presented the worst features of insalubrity 
escaped altogether or suffered only in the slightest degree," 
and " there must be (p. 24) some other condition essential 
for its action besides the known conditions of insalubrity ; 
and this unknown condition must have been absent in entire 
districts, in others only in limited spots," and " it would be 
an error to suppose that the spots it first manifests itself are 
always the worst in a sanitary point of view." A part of 
Manchester is known as Httle Ireland. " It is occupied by 
the most squalid and indigent Irish emigrants ; it has nu- 
merous pigstyes, undrained houses and cellars, and a popu- 
lation crammed to suffocation, and is in the worst sanitary 
condition of any part of Manchester," yet only five deaths 
occurred here from cholera. Reading has a population of 
twenty thousand. " It is built on a bog." Apparently the 
most favorable conditions for cholera exist here, there being 
no sewers, much filth on the surface, and pigstyes and 
slaughter-houses abound, yet only seventeen died in Read- 
ing from cholera. On the other hand, at Margate Infirmary 
there were nine deaths from cholera out of two hundred and 



CHOLERA, 299 

twenty people. Here it is " remarkably healthy on a chalk 
cliff, close to the sea." At Southampton the disease was 
most violent in a high situation detached from the town. It 
broke out at Torton Barracks, where the " supply of water 
is excellent, and there are means of ventilation and cleanli- 
ness." It appeared in Boston workhouse, which is well 
ventilated, clean, and has a good dietary. It broke out in 
Seaham harbor, where " sewerage and drainage are excel- 
lent." At Stafford " the most favorable condition for the 
attack of cholera existed ;" there are no sewers, and slaugh- 
ter-houses and pigstyes abound. In Stafford there were but 
two cases of cholera, and no death. " There was nothing in 
the locality to account for the outbreak at Hertford jail. 
Prison generally healthy." At Bridgenorth there is "no 
drainage ; filthiness is extreme, and there is no ventilation." 
There was but one case of cholera in Bridgenorth. 

Dr. Graves * boldly expresses his doubt of the accuracy 
of Dr. Sutherland's report, that cholera affected undrained 
and filthy localities only, for the course of the epidemic in 
Ireland in 1849 contradicts it entirely. Some of the health- 
iest localities in that country were the worst affected. 
During the epidemic in Dublin, it did not appear in the 
poorer and less healthy districts any more than among the 
richer and more healthy. The best ventilated and drained 
streets were not more exempted than those in an opposite 
condition. In Tralee the best part of the town was the 
part chiefly devastated. The well-clad, the rich, and the 
temperate were carried off, while the poor and intemperate, 
who lived in the lower quarters, escaped. In the lunatic 
asylum at Limerick the cholera claimed many victims, yet 
the institution is a model of cleanliness, free from bad 
odors, and not uncomfortably crowded. The diet of the 
inmates is good and regular, and their minds, on account 

■5^ Dublin Medical Journal, vol. x. 



300 VAGARIES OF SANITARY SCIENCE. 

of their mental condition, not harassed by fear of disease. 
Everything here was in contrast to Limerick jail, which 
abounded in nuisances and was greatly overcrowded, yet 
the patients in the asylum suffered severely, " while the pris- 
oners in the jail altogether escaped." 

Some districts in Dublin, which suffered in 1832, escaped 
almost entirely in 1849. Church Street, which is notorious 
for bad sewerage and bad situation, is an example, while 
the village of Castleknock, three miles from DubHn, an ele- 
vated site, well drained, which was untouched in 1832, lost 
half its inhabitants in 1849. No town is better drained 
than Parson stown, but the inhabitants suffered in far greater 
proportion than other places in Ireland. The village of 
Bray is on the site of a granite mountain, is celebrated for 
its health, and is a resort for invalids. It has good drainage 
and no filthy population. " Yet this village was awfully 
scourged by the cholera in 1849," while three adjacent vil- 
lages, in lower, confined, and wet positions, escaped nearly 
altogether. Carlow and Bagnalstown are extremely well 
situated, on dry soil ; they were decimated by the cholera, 
while many towns and villages notoriously impoverished 
and unhealthy escaped during the existence of the epidemic. 
In Dublin, in Patrick Street, and the adjoining parts, 
although those districts are the most densely inhabited, the 
worst drained, and the most filthy to be found in the whole 
city, there was very little cholera. Dulick has sixteen hun- 
dred people of the lowest class, " who live in a shocking 
state of filth and wretchedness," yet only two cases of 
cholera occurred there during the epidemic. Two villages 
near Dublin, in most healthy localities, built on a very dry 
soil, with good drainage, lost a fourth of their population. 

Dr. Graves says, " If we take a world-wide view of the 
progress of cholera, we shall find that its prevalence is un- 
connected with any physical peculiarity, either of climate, 
soil, temperature, water, air, or food." 



CHOLERA. 301 

In 1854* the epidemic in England had no relation to 
sanitary condition. While cholera caused 53,000 deaths in 
1849, it only caused a Httle over 20,000 in 1854. In both 
years it preferred the crowded towns in the low grounds 
near the coast, afflicting very nearly the same places. Ox- 
ford, Brackly, Towcester, Potters, Norwich, Milton, Mar- 
gate, Ramsgate, and parts of Essex and Cambridge suffered 
in 1854 more than in 1849. There were one hundred and 
forty-five districts, with a population of more than two and 
a half millions, where no case of cholera occurred. Some 
towns which suffered heavily in 1849 almost entirely escaped 
in 1854. Cholera caused 5275 deaths in London in 1832, 
14,137 in 1849, and 10,738 in 1854, showing plainly that 
sanitary condition had nothing to do with the mortality in 
that city. The cholera death-rate of 1849 was at the rate 
of 41 per 10,000; that of 1854 was 22 per 10,000. Nine 
of the districts around London suffered more heavily in 
1854 than in 1849. 

Liverpool had 1523 deaths from cholera in 1832, with a 
population of 165,000, while in 1849, with a population of 
255,000, it had 4173 deaths, yet what is called its sanitary 
condition was much better in 1849 than it was in 1832. 

Nine towns, including London, with a population of 
1,984,802, had 8845 deaths from cholera in 1832. The 
same towns, with a population of 2,920,118, in 1849 had 
25,894 deaths, yet much improvement had been made in 
their sanitary condition between 1832 and 1849. 

Dr. John Snow f says that at Lambeth are many of the 
causes which are supposed to promote infectious disease, 
yet the deaths from cholera in that district during the epi- 
demic of 1854 were 29 per 10,000. In the sub-district of 
Kensington, less densely populated, the deaths were 126 per 



* Seventeenth Report of the Registrar-General. 
f Lancet ^ vol. ii., 1856. 

26 



302 VAGARIES OF SAXITARY SCIEXCE. 

10,000, and in Clapham, a genteel, thinly-inhabited district, 
the deaths were 103 per 10,000. Again, the sub-district of 
Saffron Hill, with the slaughter-houses, catgut-factories, 
and knacker's yards of Sharp's Alley, and the Fleet ditch 
flowing through uncovered, the mortalit}- from cholera in 
1854 was only 5 per 10,000, while the Belgrave sub-district 
had 60 deaths per 10,000. 

Dr. Parkin * investigated the cholera epidemic in Jamaica. 
He says that at Green Island it was prophesied that the 
people would die of cholera like rotten sheep on account of 
the foul condition of the marsh. It was so unbearable that 
he was obliged to close his windows, with the thermometer 
at eight}' or ninety degrees. There were only thirty-five 
cases of cholera here and five deaths. He says this "pes- 
tiferous spot'' gave the most favorable results of any on the 
island as regards cholera. But on the dry calcareous hills, 
where decomposition of organic matter was least, fifty, 
sixty, sevent}- per cent, of the people were destroyed. 

On the 9th of November, 1848, a ship left Havre for New 
A'orkwith three hundred and eighty-five passengers. There 
was no cholera at Havre when the vessel sailed, and all on 
board were in good health. Sixteen days out the disease 
appeared. On the arrival at New York the vessel was 
quarantined, but '' it was said" that one person escaped from 
the station, came to the city, and was seized with cholera ; 
he was returned to quarantine, where he died in a few- 
hours. Prom this time on, during the winter, there were 
ninety-two cases in New York with forty -two deaths when 
the disease ceased. It appeared at quarantine again in 
April and became epidemic in the cit>^ soon after. 

It spread over the Eastern and Western States, made 
fearful havoc with the overland emigrants to California, and 
did not entirely disappear from the countr\- until 1855. The 

* Report on Cholera Epidemic in Jamaica, 185 1. 



CHOLERA. 303 

report of the sanitary committee of the Board of Health, on 
the cholera of 1849 in New York City, says that it broke 
out at " Five Points" about the middle of May. Cases fol- 
lowed in other parts of the city, which could have no con- 
nection with those at Five Points, and by the last of the 
month it was epidemic. During the earlier part of the 
season it raged worst in the lower wards, where many of 
the people were newly-arrived immigrants, destitute of the 
comforts of Hfe. It also raged with great violence on the 
elevated and sparsely-built regions between Twenty-fourth 
and Fortieth Streets and from Eighth Avenue to North 
River, while it was declining in the lower wards. The Board 
of Health did not ascribe this epidemic especially to filth. 

In 1865, without any known cause, and with no more 
change in the habits of the people to invite it than in its pre- 
vious tours, the cholera made another circuit of the globe. 
In April, 1866, a ship arrived in New York with cholera, 
and was quarantined. On the ist of May a case broke out 
on the corner of Ninety-third Street and Third Avenue ; on 
the 3d of May one occurred in Mulberry Street, five miles 
distant from the first. 

Dr. Harris, who reports on this epidemic, says, " How it 
chanced that an industrious and temperate housewife, re- 
siding on the hill-top that overlooks the southern end of 
Ward's Island, became the first victim, may never be so ex- 
plained as to remove just doubts of its exotic origin." 
This case was accounted for, because " it was said" that 
a few days before the woman had put some privy contents 
on a garden. The house was cleared of tenants, but in 
three days they returned ; no other case followed in this 
dwelling. Dr. Harris says that the relation of the second 
case " to any exotic cause, if there was one, was undiscov- 
ered." Three other cases followed, wide apart from each 
other, and without any known connection with any newly- 
arrived immigrant, or with each other, except that the fourth 



304 VAGARIES OF SANITARY SCIENCE. 

case washed the hnen of the third. It is distinctly stated 
that no local cause was assigned for any of these cases, except 
the privy on the corner of Ninety-third Street. No claim 
was made that it caused the cases from two to five miles 
away. The seventh case was in a house and block which 
were " the best models of neatness and comfort in the city." 
" No local cause for such disease existed there." None of 
the cases which at first occurred in Brooklyn " were traced 
to a sick immigrant, or to anything pertaining to the recent 
immigrants in the city." Dr. Harris says it is needless to 
speculate on the introduction of cholera into New York 
and Brooklyn that year. He only states the facts. 

There were no more cases in New York until June 4, 
when " an elderly gentleman, somewhat feeble," was taken ; 
" no special cause was discovered." Up to the middle of 
this month cases appeared in spots widely separated from 
each other and differing much in their salubrity, though 
there was a tendency for the disease to locate itself in the 
lower, crowded, and filthier portions of the city. Though 
the filth-theory of zymotic disease had been rapidly gaining 
ground in our country, the faith that filth is the cause of 
cholera, or that it propagates the disease, was badly shaken 
by this epidemic. That it did not rage among well-to-do and 
presumably cleanly people and in sparsely-settled localities 
as it did in poor, crowded, and filthy districts was true ; it 
was no less true that everybody in the well-built districts 
who could possibly leave the city had departed. In this 
epidemic Dr. Wendt * says, " There was but little diarrhoeal 
mortaHty in the best and cleanest parts of the city, partly 
because this population with their children always go to the 
country in hot weather." 

Dr. Harris says, " The Fifteenth, Sixteenth, and Seven- 
teenth Wards in Brooklyn, and the entire regions south 

* Cholera, 1885. 



CHOLERA. 305 

from Greenpoint to Newtown Creek were menaced, but un- 
touched." This part is notorious all over the country for 
its filthiness. Dr. Harris * says, " Whoever is conversant 
with the history and habits of cholera would safely predict 
that if its presence and ravages depended mainly or pri- 
marily upon general atmospheric conditions, or if, in our 
cities, it depended exclusively on local filth, a miasmatic 
soil, or unhygienic conditions of domestic life, then in the 
regions of Brooklyn here pointed out the pestilence would 
have committed worse havoc than in any other section of 
that city. Yet in these three most filthy and miasmatic 
wards here mentioned, with a population exceeding forty- 
seven thousand, rivalling the foreign population of the pes- 
tilence-stricken Twelfth Ward, which was only three miles 
distant, there were but eleven cases of cholera. ... In that 
particular section south from and adjacent to Newtown 
Creek and its junction" (which was overflowing with filth), 
" less than twenty-five cholera cases occurred in the whole 
season." 

From Bowling Green to King's Bridge cholera selected 
its fields and fearfully menaced all foul places. " But it did 
not reach all such places, and from several it did reach it 
speedily disappeared to return no more. . . . The cleanly, 
well-drained, and well-built districts escaped, with but three 
or four exceptions." But the people from these districts 
who were able had for the most part fled the city, especially 
the women and children. 

It broke out, early in July, on Governor's Island, where 
the drainage was perfect and the sanitary arrangements 
complete. 

At Blackwell's Island it raged, although " throughout its 
entire extent it is at all times kept in a good state of sani- 
tary police." Three hundred and sixty deaths occurred 

*Page 186. 
u 26* 



306 VAGARIES OF SANITARY SCIENCE. 

here. It raged at the Emigrants* Refuge and Hospital, 
where the sanitary condition "is generally unexception- 
able." At Randall's Island the grounds and edifices " are 
all models of sanitary care and strict police," yet the cholera 
ravaged the island. 

This report of the cholera in New York in 1866 needed 
only to have been a little more thorough in order to corre- 
spond exactly with that of the French Commission on the 
epidemic of 1832. 

One of the most important facts of the epidemic of 1866 
was the sudden outbreak in the Kings County Penitentiary. 
The building is on a " summit of a hill, is noted for its 
cleanliness and excellent ventilation, and every precaution 
that intelligence could devise had been taken to secure its 
healthfulness." Fourteen per cent, of the inmates were 
taken with cholera in a single night. The profound sani- 
tarian who reports on this outbreak discovers the cause, and 
records it in this report. At the foot of the hill is a stable, 
where are some cows and a pigsty. On the night of the 
outbreak, he says, there was not breeze enough to lift the 
vapors from these over the hill, and " in these vapors were 
the germs of the pestilence !" How the vapors from the cow- 
stable could have been lifted as high as the prison, if there 
was no breeze, is another of the impenetrable sanitary 
mysteries. 

The committee * which reported to the Suffolk District 
Medical Society, on the cholera of 1866 in Boston and 
vicinity, says that the educated and uneducated, the wealthy 
and the poor, the old and the young, the prudent and the 
imprudent, the resident and the non-resident, furnished vic- 
tims to the disease. Though the majority of cases were in 
the most unhealthy localities, locality does not afford com- 
plete protection from this pestilence. 

* Boston Medical and Surgical Journal^ February 28, 1867. 



CHOLERA, 307 

Dr. Ingraham,* of Chicago, says that in 1866, in New- 
York City, he studied what classes or trades were least 
subject to cholera. He found that men who worked in 
horse-stables (and also the famiHes ot these men) suffered 
less from the disease than any other class of people ; and he 
ascribes their immunity to the exhalations from the fseces 
and urine of the animals. Dr. Hamilton ascribes the cholera 
of 1850 at Suspension Bridge to upturned soil. That filth 
was not the only cause was proved, he said, by the fact that 
in Buffalo those living in dirty shanties by the lake escaped. 
During the epidemic of 1884 f it was shown that the tanners 
in Italy were free from cholera. The streets where tanneries 
were located were altogether spared, and the plague was less 
virulent in those towns where tanneries were plenty. Yet 
there is no occupation where putridity is continually at a 
higher point than in these establishments. 

In all of the cholera epidemics which have visited our 
country the military posts have had no immunity, although 
they are supposed to be in the best sanitary condition, so far 
as cleanliness and discipline are concerned. In 1832-33, all 
through the North and West, from Buffalo to Fort Leaven- 
worth, the cholera prevailed among the United States 
troops. In 1849 it raged among them in Texas, along the 
Rio Grande, at Governor's Island, and at Carlisle Barracks. 
It broke out even at West Point that year ; it persisted at 
Jefferson Barracks and at Fort Leavenworth in an epidemic 
form for seven years, from 1849 to 1855. It was epidemic 
on Governor's Island in 1849 ^^*^ ^^ 1852-54. It raged again 
at Governor's Island and at Hart's Island in 1866. It broke 
out on the steamer " San Salvador," which sailed from New 
York in July, 1866, for Savannah, with four hundred and 
seventy-six troops. They were put into camp at once, pre- 
sumably a clean one ; but there were two hundred and two 

* Medical Record, vol. xxvi. f London Lancet, vol. ii. 



308 VAGARIES OF SANITARY SCIENCE. 

cases and one hundred and sixteen deaths. In Jackson 
Barracks that year in New Orleans there were one hundred 
and seventy-three deaths, and the disease was carried to the 
forts below the city. During the epidemic of 1866, out of 
a total of twelve thousand seven hundred and eighty men 
in the United States army, there were two thousand seven 
hundred and eight cases of cholera, and twelve hundred and 
seven deaths. Again in 1873 it did not spare the United 
States forces. It raged in San Antonio, in Kansas, Ken- 
tucky, Indiana, and Virginia. All this occurred where the 
best sanitary conditions are supposed to prevail, and among 
troops directed by a superior order of medical talent. 

The epidemic of 1873 first broke out at New Orleans, and 
was confined to the Mississippi Valley and the Southern, 
Middle, and Western States. The first twenty-five cases in 
New Orleans were subjected to close examination, and it 
was proved that none of them were imported. All were 
residents of the city. The history of the outbreak of 1 873 
shows that it afflicted towns without any regard to their 
sanitary condition. Some most seriously visited were 
reported free from any local cause which is supposed to 
excite cholera ; while others which were notoriously filthy, 
like New Orleans, yielded only a few deaths. During the 
eight months that the epidemic prevailed, New Orleans, with 
two hundred thousand inhabitants, lost only about two hun- 
dred and fifty from cholera. 

One peculiarity of this epidemic * was that it was most 
malignant in small country towns and villages. It prevailed 
greatly on the thinly-settled Kansas prairies. There were 
no sewers or drains to lay it to in Kansas, neither were 
the people specially filthy there. But the sanitarians were 
ready with a reason ; they said the cholera persisted in 
Kansas because animals that died on the desolate prairie 

*Wendt'« Cholera." 



CHOLERA. 309 

were left unburied, and the effluvia from them caused the 
disease. 

During the epidemic of 1884-85 in the south of Europe, 
the cholera, as in France in 1832, " sported with human pro- 
visions." It chose a southerly route to enter Europe this 
year ; it was located mainly along the Mediterranean ; Russia 
and Germany escaped entirely. Paris alone of the northern 
cities suffered. If the outbreak in Europe in 1884 was a 
part of the Eastern epidemic, then the disease made a sudden 
bound from Egypt to Toulon. The "fissure" by which it 
entered Toulon has never yet been discovered. 

Nobody disputed that Toulon, where it first broke out in 
1884, was filthy; but it soon reached Marseilles. Marseilles 
had suffered terribly from cholera in 1865 ;* but during the 
nineteen years that followed it had been renewed in pave- 
ments and sewerage. Her water-supply was equal to any 
on the Continent, except that of Rome ; her markets were 
carefully inspected, and in sanitary condition and regula- 
tions she was unsurpassed in excellence by any European or 
American city. The health of the city was good. At the 
time of the outbreak at Toulon the deaths at Marseilles were 
less than two-thirds the normal death-rate for that season. 
The outbreak here was sudden and simultaneous in all parts 
of the city, and several of the earlier deaths occurred in the 
cleanest and handsomest quarters. Long before the first 
rumor of trouble extra precautions were taken to have the 
town cleansed and made ready. But the disease came and 
swept the city. The sewers which flowed into the tideless 
Mediterranean were declared to be the cause. On the other 
hand, the records showed that the old port of Marseilles, 
which was the main cesspool for its sewage in 1865, was 
almost exempt from cholera that year. Only one death 
occurred on all the shipping there assembled. The consul 

* United States Consular Report, 1885. 



310 VAGARIES OF SANITARY SCIENCE. 

says that to explain " this paradox" " it is said that the 
miasm of that particular part acted upon the homoeopathic 
principle, as an antidote to the venom of the epidemic." 
Why the miasm should prevent the disease in 1865 and 
cause it in 1884 was never explained. The consul says, 
" All that energy and liberality could perform, all that sani- 
tary science could suggest, has been done ; but the pestilence 
is here and defies restraint." Toulon, says the report, is 
extremely filthy ; but " filth alone does not create cholera. 
If it did, Toulon would have a yearly epidemic." Lyons 
escaped,* as it did in 1832, 1849, and 1853. Only one death 
from cholera occurred there during the epidemic of 1832, and 
there were only twenty-seven cases in 1884. Her escape at 
any time was not due to cleanliness. In 1849 f cholera broke 
out at the military hospital at Lyons. " Contrary to expec- 
tation, it is confined to the garrison." " Who would have 
believed before 1832 that Lyons, a damp, uncleanly, un- 
healthy city, full of workmen the majority of whom are in a 
wretched state of want and filth, would escape the scourge ?" 
And, the writer adds, how strange, now that it has appeared, 
that it should be confined to that part of the people " who 
are decidedly in far better condition than the bulk of the 
population." Nobody has yet given a satisfactory reason 
why Lyons, Versailles, and Birmingham have never suffered 
from epidemic cholera. 

The disease at first skipped Genoa, and the people ex- 
pected to escape. The city was clean, and the consular 
report says that disinfectants were used everywhere. The 
habitations of the lower classes were inspected daily. No 
city " could take more precautions" than did Genoa ; " great 
pains were taken day and night to keep the city clean." 
Genoa was " in as healthy a state as it is possible for human 

* Bulletin de r Academic de MMecine, 1884. 
■j- London Lancet, January, 1850. 



CHOLERA. 311 

agency to make it." But in a few weeks its inhabitants were 
flying with terror in all directions. Consul Fletcher writes 
that cholera at Genoa seeks and finds its victims in every 
part of the city. The hitherto healthiest localities and the 
widest and most airy thoroughfares have it. 

It passed by filthy Leghorn and other filthy cities in Italy in 
disdain, but struck no less filthy Naples, which was ravaged 
by the disease. A correspondent of the London Lancet^ 
writes that the mode in which cholera attacked the people 
of Naples has been very perplexing to the sanitarians. The 
narrow, ill-ventilated streets, where human beings teem like 
rabbits, have been precisely those places in which cholera 
has numbered the fewest victims ; while the locaHties which 
are in marked contrast have filled the hospitals and ceme- 
teries. " The ill-fed, badly-clothed, unwashed inmates of 
the rookeries have come off very lightly in comparison with 
the well-dieted, comfortably-clothed, not uncleanly bour- 
geoisie." It is naively remarked, " All this, however, should 
not shake our faith in the efficacy of pure water and cleanly 
dwellings." 

Turin and Milan, Venice with her canals loaded with filth, 
Florence, and Rome escaped, or were only lightly visited. 
Let those who know by observation what those cities are in 
respect of cleanliness decide whether that cleanliness pro- 
tected them. It avoided Palermo that year; but the consul 
writes, " The sanitary condition of the city had little or 
nothing to do with its escape." It was the filthiest of all 
the Italian cities. Active measures were taken to put it in 
good sanitary order. The drains were disinfected, the 
houses of the poorer classes whitewashed, the slaughter- 
houses and markets were inspected, the sale of unripe fruit 
and suspected food was forbidden. Nevertheless, the next 
year the pestilence came and threatened to sweep its inhab- 

* Medical Record, vol. xxvi. 



312 VAGARIES OF SANITARY SCIENCE. 

itants from the earth. The consul writes that, notwithstand- 
ing the bad sanitary condition of Palermo, the general mor- 
tality there is comparatively small ; " the deaths between the 
years 1872 and 1881 being only 26.9 per thousand, and for 
the last few years even fewer ; while the mortality of Rome, 
Turin, Venice, and Milan was 33.9 per thousand. Cholera 
raged at Gibraltar, although this place was pronounced in 
excellent sanitary condition. 

Hyeres is a town of twelve thousand people. It is distant 
a few miles from Toulon, and has constant communication 
with that city, which was the centre of the pestilence. Its 
sanitary condition * is truly deplorable. There is a ditch 
here which is called a sewer by compliment ; it is three feet 
deep, and covered with flag-stones. The hot sun acts on the 
stagnant sewage below, which rapidly ferments. The fall is 
insufficient, so that " in one place the sewer had an inclina- 
tion upward." It takes the overflow of numerous cess- 
pools, and, as none of the conduits are trapped, the foul air 
rises into the houses. Cesspools abound on all sides, and 
" are, for the most part, built immediately under the houses." 
Untrapped pipes draw the foul air into the dwellings. The 
soil-pipes of the privies, being within the house, have a higher 
temperature than the outside air, and are active ventilators 
of the privies into the houses. There are no means of 
excluding effluvia from the dwellings, which are impregnated 
with the stench from the cesspools, brought up by the soil- 
pipes, and also by the sewer-gas drawn up through the 
waste water-pipes. "The prospect may well awaken the 
keenest alarm." The writer says that if one or two cases 
of cholera are imported, then there will be no safety for the 
inhabitants. 

Such was the sanitary condition of Hyeres, July 19, 1884. 
So like Newport in sanitary condition, it also resembled it in 

* Loudon Lancet, 1884, vol. ii. 



CHOLERA, 313 

salubrity, for it had long been renowned for its healthfulness. 
It was especially favored by the English, who had found out 
by wide experience that a residence in Hyeres recuperated 
their health. In the same volume of the Lancet^ just two 
months and one day later, is an article on the " Immunity 
from Cholera at Hyeres." We are now told that it has 
" climatic advantages," though it is only eleven miles from 
Toulon, and may be considered a suburb of that city. The 
population of Hyeres has been suddenly augmented more 
than twelve per cent, by fifteen hundred fugitives from 
Toulon, some of whom fell ill of cholera after their arrival. 
" None of these cases determined a local outbreak." It is 
still in the same unsanitary condition. Most houses have 
cesspools ; the pipes are untrapped, and such sewers as exist 
are, for the greater part, defective. The streets are washed 
three times a day and some disinfectants are thrown about 
in them, which, however, will not quite explain why Hyeres 
has no cholera. " Something more than this is requisite to 
account for the remarkable immunity of Hyeres." We must 
search deeper. 

We concentrate the rays of Sanitary Science on this sub- 
ject in their greatest effulgence and find a solution of the 
mystery. The editor of the Lancet wrote, with apparent 
gravity, that "the probable explanation of this phenom- 
enon (the immunity of Hyeres) lies in the granitic stature 
of the soiir Given a " granitic nature of the soil," and 
open, reeking sewers, overflowing cesspools, soil-pipes and 
waste-water pipes ventilating privies and cesspools into 
the houses, and impregnating these with their repulsive 
effluvia, are entirely harmless. But why this " granitic 
nature of the soil" was not discovered and disclosed in 
July, so that the minds of the people at Hyeres could be 
composed, instead of tortured about the cholera, was never 
explained. 

At a sitting of the Paris Academy of Medicine, September 
o 27 



314 VAGARIES OF SANITARY SCIENCE. 

I, 1884,* the epidemic in one hundred and four places was 
reported on. In seventy locahties it was ascribed to impor- 
tation and contagion. Twice it was caused by soiled cloth- 
ing sent from infected localities ; and in seven instances it 
was ascribed to a stream of water flowing from such locali- 
ties. It appeared in twenty-five places in which the physi- 
cians could find no imported case, nor any manner in which 
contagion bore any part in its transmission. Once appear- 
ing, its spread is accounted for by soiled clothing, by contact 
with patients, and by residence in houses which contained 
cholera. It prevailed in fourteen places in which the customs 
and habits of the people, in respect to filth and fecal matter, 
conformed to all of the prescriptions of hygiene. In ninety 
towns it could be said there was uncleanliness, and fecal 
matters were not properly cared for ; but the report takes 
no notice of the hundreds of towns in France, like Hyeres, 
in which this condition of filth and fecal matter was present, 
which were untouched by the disease, though, like Hyeres, 
they afforded a refuge for fugitives from infected parts ; and, 
unlike Hyeres, they were not favored by a " granitic nature 
of the soil." Dr. Shakespeare f says, "It was not for the 
lack of grossly unhygienic circumstances that the cholera did 
not ravage the greater part of France during 1883-85." 

At the sitting of the Paris Academy of Medicine, October 
7, fifty other places were reported on where cholera had pre- 
vailed. In thirty-nine of these it was assigned to importa- 
tion or contagion. The physicians of the remaining eleven 
towns were firm in their belief that it was generated on the 
spot. They could find no case of importation, nor any trace 
that it had been communicated by contagion. In many of 
the places where no contagion could be discovered, persons 
of various professions and in different walks in life, living 

* Bulletin de I'Acad^mie de M6decine. 
f Cholera in Europe and India. 



CHOLERA. 315 

remote from one another and without any communication, 
were simultaneously seized. A few members of the Academy 
were positive that the disease could and did arise sponta- 
neously; that in many instances neither importation nor 
contagion would account for it. M. Ricord expressed his 
disbelief in either, basing his opinion on observations of 
the epidemic of 1832 and those which had followed it. He 
thought that it might arise spontaneously, under some 
epidemic influence not yet understood ; and that a quaran- 
tine was useless and vexatious, except such a one as would 
quarantine healthy people out of an infected district. That, 
he said, would be truly hygienic. 

The alleged causes for the disease in France this year are 
bad water, want of ventilation, topographical situation, want 
of personal care, excesses, fear, imprudence, extreme heat, 
exposure to cold, filth, and particularly fecal matter. The last 
was specially insisted on as a prime cause, and no great oppo- 
sition was made to it by the members of the Paris Academy. 
But at a sitting on the 26th of August, M. Bouchardat said 
that it had been the rule, in latter times, to assign great 
importance to breathing air charged with emanations from 
putrefying matter, as a cause of cholera nostras. While he 
admitted the reality of this cause, he thought it was much 
less dangerous than was supposed. He then made the 
remarkable statement that, in his long career in Paris, com- 
prising a service of twenty-two years at Hotel Dieu and his 
inquests of the Conseil de Salubrite, he had never known a 
death from cholera nostras among the great number of men 
employed in the depots for dead animals, nor in the depots 
for fecal matters, nor among the cleaners of privies, nor 
among workmen in sewers. He thought we ought not to 
exaggerate faeces and putrid matters as the cause of cliolera 
nostras. He added that he had never known a case of this 
disease which arose from bad water. 

At a sitting of the Academy, the nth of August, M. Le 



3l6 VAGARIES OF SANITARY SCIENCE. 

Roy de Mericourt declared that he could not see the rela- 
tion of fecal matter to cholera. For ages fecal matter had 
been accumulating at Marseilles, yet no cholera appeared 
there until 1832. All of the towns on the Mediterranean 
shore were, in respect to fecal matter, like that city, but 
they were not afflicted with cholera. The crews of ships 
are often decimated by the disease, but there is no accumu- 
lation of faeces on shipboard. At a later sitting M. Meri- 
court related an epidemic which occurred in 1854 among 
the French fleet in the Black Sea, and which destroyed in 
eight days eight hundred men out of a force of three thou- 
sand. M. Guerin replied that a certain change must take 
place in the faeces {il faut done que des conditions particu- 
lieres viennent alterer les maiieres fecales) in order to pro- 
duce an epidemic. M. Mericourt asked his colleagues of 
the biological and chemical section whether accumulated 
fecal matter could acquire by time such pernicious qualities. 
M. Bechamp replied for this section, saying that all experi- 
ments proved that noxious germs escaping from the body 
lost their infective power (ne tardent pas a perdre leur mor- 
bidite) so soon as putrefactive changes commenced. Cholera 
germs, he said, could not exist in putrefying matters. 

Whenever the cholera has afflicted Milan, which has hap- 
pened on three different occasions, the people employed on 
the irrigated fields which receive the city's sewage and faeces 
have always escaped. When the disease raged at Edin- 
burgh and Leith in 1865, — as we have seen on a previous 
page (68), — not a case occurred in the vicinity of the 
meadows which received the fecal excreta of the cholera 
patients in those cities. In 1884, during the cholera epi- 
demic at Paris, Gennevilliers received one-half of the city's 
sewage ; not a case of cholera occurred among the three 
thousand people in that commune, although they were daily 
exposed to cholera discharges. 

In the winter of 1891-92 cholera assumed an epidemic 



CHOLERA. 317 

form in the East, and began to creep slowly but stealthily 
westward, taking a northern route, as it did in 1832 and 
in 1849. It ravaged Persia and Russia during the spring 
and early part of the next summer. The middle of July it 
had reached St. Petersburg. Without another note of 
warning, at one bound, it struck Hamburg, the first death 
from that disease occurring there about the 1 8th of August. 
By the 20th of the month there had been eighty-five cases 
and thirty-six deaths. The 21st of August there were 
eighty-three cases and twenty-two deaths. The next day 
there were two hundred cases. There was much running 
to and fro of bacteriologists, and it was the 22d of August 
before a microscopical examination determined that the dis- 
ease was true Asiatic cholera. Before bacteriology would 
permit that it should be called by its right name there had 
been three hundred and sixty-eight cases. The first was 
hardly proved when the epidemic was wide-spread. There 
were six hundred and seventy-one cases on the 26th of 
August, and two days later eleven hundred and two, which 
was the highest number seized on any one day. Later, 
with but slight variation, the number of cases declined 
daily, so that on September 3 there were seven hundred 
and eighty. On the loth the number had fallen to four 
hundred and thirty-nine, and on the 17th of September 
there were three hundred and thirty-eight cases, on the 
24th there were one hundred and twenty-six, and forty-three 
cases on the ist of October.* The number after this on 
any one day was not higher than forty-three, and with one 
or two exceptions it continued to decline until October 19, 
when there was one case and no death. From the 17th of 
August to the 20th of October there had been 17,988 cases 
and 7608 deaths. 

It is not known how cholera effected an entrance into 

* Munch. Med. WocA., October 29, 1S92. 
27* 



3l8 VAGARIES OF SANITARY SCIENCE. 

Hamburg. The sanitarians said, with one accord and with 
a great uproar, that it was caused by the fiUh of the city, 
which they described as a place " where dirt reigns king, 
to whom all pay homage." Cholera was a filth-disease, 
therefore Hamburg must be filthy, or it could not entertain 
cholera. When the disease attacked the low part of the 
town, it was the filth in the soil that attracted the microbe. 
When it raged among the overcrowded, the poor, the 
wretched, the drunken, which it did more than it did among 
the rich, it was the filth in which the former lived that the 
microbe sought for an abode and nutriment. When the 
disease seized the rich, the well-to-do, and the temperate, 
which it did often enough, those of them who had not fled 
the city, the reformers ascribed it to the filthy water. Those 
who knew the least of cholera, and who perhaps had never 
seen a case of the disease, talked the loudest about it. On 
both sides of the Atlantic the buccal flux was something 
tremendous. Out of it the sanitarians distilled the maxim ; 
cholera, being a filth-disease, is carried by filthy people to 
filthy places. Nothing could be more manifest to the sani- 
tarian eye than the cause of the epidemic in the great 
German port. The problem explained itself The filthy 
Russian Jew had transported the filth-disease, cholera, to 
filthy Hamburg. Out of this huge volume of words they 
condensed this other precept, which, if strictly followed, 
would be an unfailing protection against cholera, — boil the 
water and keep clean. And the reason why Hamburg in 
the course of nine weeks had eighteen thousand cases of 
cholera and nearly eight thousand deaths, was because it 
had not defecated with precaution and delicacy, and had 
forgot to boil its water. Probably none of these sanitarians 
had ever seen Hamburg. What were the facts ? It was a 
healthy city. Its death-rate for 1891 was 23.5. It was one 
of the cleanest towns on the continent. Pettenkofer said it 
was the type of a well-drained city. The London Lancet 



CHOLERA. 319 

of October i said, " Here was a city with fairly good 
drainage, not overcrowded, no famine, but little of the direst 
sort of poverty, a creditable condition of house and personal 
cleanliness." Dr. Seibert * says that he has known Ham- 
burg for more than twenty years ; has visited the finest 
streets and the smallest alleys ; the houses of the well-to-do 
people as well as those of the poor. It is one of the clean- 
est of cities, and he intimates that the superior neatness of 
its streets, houses, and people is to be contrasted and not 
compared with that of New York. Besides, the houses in 
which the disease first broke out were new and in a far 
better hygienic condition than those of the older parts of 
the city. There was nothing, in fact, about Hamburg's sani- 
tary condition to favor the appearance of cholera. The 
Jew, who, since the tenth century, had had nearly every 
epidemic in Europe laid to his door, proved his innocence 
through an alibi. He had not been to Hamburg at all for 
more than a month previous to the outbreak, but had been 
embarked from another point. When this depot was care- 
fully searched for cholera it was proved that there had been 
no case of that disease among the Jewish emigrants. From 
Hamburg the disease was carried to other German towns, 
to Belgium, where there were over eleven hundred cases 
and nearly six hundred deaths, to Holland, England, and 
the United States. 

It is probable that medical men were never quite so puz- 
zled regarding the origin and spread of cholera in Europe 
as in 1892. It broke out in the suburbs of Paris, at the 
prison of Nanterre, on the 2d of April.f Soon after it ap- 
peared in twenty-six different communes. In those first 
attacked it is certain there was no imported case. Although 
there was constant communication between the city of Paris 

* New York Medical Journal^ December lo, 1S92. 
\ Revue (VHygilne^ July, 1892. 



320 VAGARIES OF SANITARY SCIENCE. 

and the outside communes, cholera was present in the latter 
for four months, and had caused four hundred deaths before 
a case broke out in the city. The mortality was appalling ; 
in some communes it was as high as ninety per cent, of 
those seized. In July, one month before any case occurred 
at Hamburg, cholera appeared in Havre and became epi- 
demic. Here were twelve hundred and sixty cases and 
four hundred and ninety deaths. The mortality was higher 
than at Paris ; of the first fifty cases, forty-eight died. The 
origin of the epidemic at Havre is unknown.* It was as- 
cribed to the arrival of the " Rugia" from Hamburg," but 
there had been seventy-two deaths from cholera at Havre 
before this vessel appeared in the port. It broke out in the 
insane asylum at Bonneval ; f here were forty cases and 
twenty-eight deaths. No trace could be found of its en- 
trance into this institution. It appeared at Rouen; the 
sanitarians again raised the cry of filth. Dr. Bataille { says 
no cause could be assigned for its presence at Rouen. 
There was no imported case. During this epidemic in Eu- 
rope there was a general disposition eveiywhere on the 
part of the sanitarians to traduce the water, though in not 
a single instance was there any proof that any of the incul- 
pated fluid had received the cholera infection. It was said 
that Professor Koch had expressed his opinion {gutachtung) 
that cholera dejections had in a certain way {gewissermassen) 
got into the Elbe, and had been carried up-stream by 
the tide to a point above the intake of Hamburg's water.§ 
We have looked in vain for this "opinion" over Profes- 
sor Koch's signature. His fame is not founded on his 
" opinions," but on his investigations. As late as October 27, 



* La Normandie Medicale, September, 1892. 

f Mouvement hygidne. 

X La Normandie Medicaie, August 15, 1892. 

§ Deutsche Med. Woch. u. Aertz. Cent. Auz.^ August and September, 1892. 



CHOLERA. 321 

1892,* no cholera bacilli had been found in the Elbe, or in 
the reservoirs or pipes which held and carried this water for 
the people of Hamburg. The irregular distribution of the 
cases, and the course of the epidemic, proved that it could 
not be explained on the water-theory. If Hamburg's 
cholera was caused by the Elbe water, no more positive 
proof can be given of the utter worthlessness of bacterio- 
logical examinations to determine the character of a water- 
supply. If, at any time during this epidemic of eight weeks 
or more, which caused nearly eight thousand deaths, speci- 
mens* of this water had been given to bacteriologists to ex- 
amine, they, not knowing its source, would not have 
pronounced it an unwholesome beverage. By municipal 
ordinance all water which was consumed in Hamburg was 
commanded to be boiled. This was begun almost immedi- 
ately after it was shown that cholera was in Hamburg. 
Boiling the water must have been general by the 25th of 
August. A few days later the number of cases began to 
diminish, and doubtless this epidemic will go into sanitary 
history as having been arrested by boiling the water. 
However, we cannot close our eyes to the fact that nearly 
seventeen thousand cases of cholera out of a total of nearly 
eighteen thousand broke out in Hamburg after the water was 
boiled. But the germs had now spread through the city. 
What shall we say, then, of the disinfection that was prac- 
tised? Dr. Seibertf tells us that it was performed with 
scrupulous exactness by a corps of trained disinfectors ; 
there was rubbing and scrubbing, and steaming and burning 
and fuming, not under the direction of the tattling sanitarians, 
but supervised by scientific men like Koch and Rahts, genuine 
hygienists and conscientious investigators, who have the 
respect, if not the entire confidence, of medical men every- 



* Deutsche Med. Woch., October. 

•f New York Medical Jomtial, December 10, 1892. 



322 VAGARIES OF SANITARY SCIENCE, 

where. Previous to 1892, Hamburg had had sixteen visits 
from cholera ; it had not caused more than sixteen hundred 
and seventy-four deaths at any one outbreak. In 1873 it de- 
stroyed one thousand and one people. Since that time the 
hygienic condition of the city had been improved, in so far 
as its people had better and more varied food and raiment, 
more commodious shelter, less work and more wages, a 
general advancement in material comforts, and a higher 
moral and intellectual progress. Yet in spite of these ad- 
vantages, when it was smitten by cholera in 1892 it lost 
eight or ten times as many of its people as it did twenty 
years before when no attention was paid to scientific disin- 
fection. Regarding the cause and prevention of cholera, 
the epidemic in Hamburg in 1892 has only deepened the 
mystery. 

The condemnation of the river-water induced the citizens 
to bore wells, and although these had long before been 
pronounced not only unfit, but dangerous to use, and al- 
though they were only twenty or twenty-four feet deep, and 
took the surface-drainage through the old soil of the city, 
the well-water was now shown, ** by chemical and bacterio- 
logical experiment," to be good.* 

In the suburbs of Paris, as late as July, M. Proust declared 
that the tie which connected all cases was the water of the 
Seine, though the Seine water inside the city did not pro- 
duce the disease.f Towards the last of July it broke out in 
Paris, and its progress there had no relation to the Seine 
water. M. Ach. Lavache % shows that the two zones which 
were most gravely affected by cholera in Paris in September 
received their water, one from the Seine, the other from the 
Marne and the Dhuys. The zone supplied by the Seine, 
with a population of 513,576, gave one case of cholera to 



* Aertz. Cent. Auz., October, 1892. 

f Revue d' Hygiene, July, 1892. % Ibid., October. 



CHOLERA. 



323 



3292 people during the first half of the month, and during 
the last half one case to 5035 people. The other zone, sup- 
plied with water from the Marne and the Dhuys, having a 
population of 531,532, gave one case of cholera to 2242 
inhabitants during the first half of September, and one case 
to 5537 people during the last half of the month. In either 
case this poisoned water of the Seine, which more than a 
half-million of people were drinking, affected only one 
person in 3292 during the first half of September, and not 
one in 5000 during the second half of the month. Dr. 
Gibert,* in reviewing the causes of cholera in France, denies 
the influence of the Seine water. He has never seen pol- 
luted water cause epidemic cholera in Europe ; filthy water 
may cause colic and diarrhoea, but the cholera that travels 
from place to place, never. If Seine water can cause cholera, 
then, says Dr. Gibert, pull down sanitary barriers, — they are 
useless and expensive, — and away with the luxury of grand 
international conferences, where we so copiously discuss 
preventive methods of cholera. 

The tables of the ravages of cholera in India would seem 
to show that it has no claim to be considered a filth-disease. 
The deaths in Bombay f for seventeen years, 1866 to 1883, 
were as follows : 



46,743 

6,937 

684 

16,694 
7,904 

37,594 



It cannot be that these figures represent the filth of 
Bombay; that it was quite dirty in 1866, and that in 1867 it 
was five times cleaner, to grow more than ten times as dirty 



866, , 


23,027 


1872 . , 


. 15,642 


1878 . . 


867. . 


5,143 


1873. . 


. 283 


1879. • 


868. . 


6,348 


1874. . 


37 


1880. . 


869. . 


52,330 


1875 • . 


. 47,555 


1881 . . 


870 . . 


2,666 


1876. . 


• 32,117 


1882 . . 


871. . 


5,281 


1877. . 


. 57,252 


1883 . . 



* La Normandie Alidicale, September, 1892. 
•}• Shakespeare, *' Cholera in India and Europe." 



324 VAGARIES OF SANITARY SCIENCE. 

in 1869, when there were 52,330 deaths; that the next year 
the country was very clean, when only 2666 deaths were 
reported, again to rise to more than 15,000 deaths two years 
later. It is not complimentary to our common sense to tell 
us that in 1874 the filth was well-nigh all removed, when 
there were only 37 deaths, and that the next four years it 
was horribly dirty, when more than 1 80,000 died of cholera 
in Bombay; or that in 1880 it suddenly grew clean again, 
when only 684 died ; and that in 1883 was a new accession 
of filth that caused 37,954 deaths. It would disgrace the 
anility of a country neighborhood to account in this way for 
the variation of cholera deaths in Bombay. The average 
annual death-rate from cholera per 10,000 in India varies, in 
the twenty-seven districts, from 6.05 to 49.51. Are we to 
understand that these figures represent the comparative 
cleanliness of the districts ? For example, is Noakhally 
more than eight times as nasty as Dinagepoor ? 

Dr. J. M. Cunningham * says the causes of cholera are 
not to be settled by theoretical discussions, however clever 
or learned, but by a study of the facts. Though an earnest 
advocate of abundant and agreeable water, proper drainage, 
and every other measure which can possibly add to human 
comfort, and thereby to human health, he declares that " the 
cause of cholera, what governs its distribution and its rela- 
tive incidence in different places, is still as inscrutable as 
when the disease first appeared," and " it must be remembered 
that the distribution of cholera, as may be proved beyond all 
doubt, is not regulated by conditions of filth or cleanliness ;" 
and that quarantine, isolation, and disinfection have utterly 
failed to prevent or arrest outbreaks among European 
troops, even when carried out under the most careful super- 
intendence. And the Indian Sanitary Commission f says no 



* Epidemic Cholera in India, 1872-75-79. 
f London Lancet, 1891. 



CHOLERA, 325 

satisfactory explanation is given of its almost simultaneous 
appearance in many centres of a district, nor of the strange 
exemption of certain areas environed by cholera. 

But the final blow to the filth-origin or propagation of 
cholera was given by Koch himself, at the very time when 
he announced his discovery of the bacillus, called the comma 
bacillus. He premised * that we should suppose that, in 
their struggle against pestilence, people would start from a 
scientific basis ; but this had not been done, especially with 
cholera. He showed that its bacillus flourished best at a 
temperature between %6^ and 104° ; below 63° the growth 
is slight, and it ceases below 61°. He was inclined to 
believe that if comma bacilli were brought into a putrefied 
liquid containing putrefactive bacteria, they would not come 
to development ; and that if they were put into a sink or 
cesspool they would die, and " there would be no necessity 
of disinfecting." If there was a trace of acid in the fluid 
in which the bacilli were placed, they were stunted ; if the 
fluid was acid in a marked degree, they died at once. He 
showed that the sulphate of iron, which had been so lauded 
as a disinfectant, actually exerted the opposite effect; and he 
says, " The process of putrefaction that goes on of itself in 
the cesspool is sufficient to kill the comma bacilli." Sul- 
phate of iron only stops the putrefactive process and pre- 
serves them. Subsequent experiments have shown that 
wherever filth abounds and putrefaction is going on, with 
the presence of putrid bacteria, the comma bacilli are 
quickly destroyed. This helps to solve the question why 
those who, in times past, have been exposed to filth in its 
most repulsive forms have so often escaped the cholera ; and 
why it has seemed to endure longest about those places 
where disinfectants have been freely used, and where putre- 
factive changes are least observed. In speaking of the 



* British Medical Journal, 18S4. 
28 



326 VAGARIES OF SANITARY SCIENCE. 

benefits that were to arise from the discovery of the cholera 
bacillus, Koch said, " But, above all, we can deduce this 
advantage : that an end will at length be put to the fearful 
squandering of disinfectants ; and that miUions will not 
again, as in the last epidemic, be poured into gutters and 
cesspools, without the slightest advantage." 

Three hours after these baciUi were dried they died, unless 
they were in compact masses ; and then they did not live 
longer than one day. The common water-bacteria always 
suffice to destroy the comma bacilli. " Everywhere," Koch 
says, " where I was able to come across a liquid containing 
bacteria, I examined it in search of comma bacilli, but never 
found them in it." He could not find them in the sewers 
of Calcutta, nor in the extremely polluted water of the 
Hooghly, nor in a number of the tanks which contained very 
dirty water. He did not believe that they could multiply in 
well- or river-water, — certainly not if either had a temper- 
ature as low as 6i°, — because neither contained the concen- 
trated nutriment for their increase. He could only imagine 
that they could develop at some point in perfectly stagnant 
water, where there happened to be vegetable or animal 
matter suited to their growth. But when the water has a 
rapid motion, or is subject to frequent change, the conditions 
of growth, even if the nutriment is there, are less easy, or 
do not occur at all. In but one instance did he find the 
comma bacillus in water, and this was in a tank where the 
soiled linen of a cholera-patient had been washed. 

Surgeon-Major D. D. Cunningham * records his experi- 
ments with the cholera bacillus in earth mixed with human 
fecal matter. They extended over a period of time from 
the 1 6th of December to the 2ist of March. He says, " In 
the above experiments we find that very large quantities of 
comma bacilli introduced into fecally-contaminated soil, and 

* Scientific Memoirs, Medical Officers in India, 1887. 



CHOLERA, 327 

exposed to conditions similar to those to which the bacilli 
entering the soil at Calcutta are normally liable during the 
period of year dealt w^'ith., failed to multiply, and, on the con- 
trary, rapidly and completely disappeared'' (italics ours). 
He further continued these experiments, and adds, " The 
above experiments having clearly shown that comma bacilli 
rapidly and permanently disappear from portions of soil, 
whether pure or fecally contaminated, exposed to the ordi- 
nary conditions prevalent in Calcutta, an attempt was made 
to ascertain whether any other materials to which they are 
likely to gain access were more favorable to their continued 
existence." Cow-dung was now taken. In its normal state 
(that is, unboiled) the development (of the comma bacilli) is 
either entirely repressed or very much enfeebled, showing 
" that in this medium the commas have no capacity for the 
assumption of a resting condition." In media, such as 
fresh cow-dung, which appear to afford everything neces- 
sary to their continued vitality and multiplication, the pres- 
ence of other organisms normally present in the medium is 
sufficient to repress or absolutely to suppress further devel- 
opment, and in other media, such as human fecal matter, 
even the aid of artificial measures calculated to place them 
at an advantage in the struggle are insufficient to be of any 
avail in securing their continued existence." And again, in 
1889, Surgeon Cunningham * records five experiments made 
with the comma bacilli in water, and six experiments in 
earth. In fairly clean, unboiled water they disappeared in 
four or five days at the temperature of the air in Calcutta. 
In foul, unboiled water they disappeared in four days ; in 
foul, boiled^ sterilized ivater they lived for twenty-five days. 
Mixed with garden-earth they disappeared in from nine to 
twenty-six days. Mixed with garden-earth and faeces they 
were gone in six days ; while if the garden-earth and fcBccs 

•5^ Scientific Memoirs, Medical Officers in India, 1SS9. 



328 VAGARIES OF SANITARY SCIENCE. 

were boiled, sterilized, they were " still present after forty-seven 
days!' Surgeon Cunningham says, " Taking the case of 
the present experiments on their behavior (the comma 
bacilla) in soil and water of various degrees of pollution, 
the evidence was entirely in favor of rapid extinction and 
against the development of any specially resistant forms. 
And under normal circumstances they are singularly inca- 
pable of holding their own in the struggle for existence," 
and that " they very rapidly succumb" if they are not 
placed in a medium that has " not been specially sterilized 
for them." 

Dr. Watson Cheyne * says the comma bacillus is never 
found in putrefying materials. Nicate and Rietsch f could 
find no comma bacilli in the discharges of cholera patients 
which had resumed the fecal odor and color. When the 
material in which they put the bacilli began to take on 
putrefaction, they rapidly disappeared. " The rapid disap- 
pearance of the microbe under the influence of putrefaction 
is a real fact." These repeated trials demolish entirely the 
filth-pathology of cholera in so far as the germ of that dis- 
ease is concerned. 

Dr. Macnamara J says that the cholera bacillus quickly 
disappears in the drainage of cesspools. 

Dr. Sternberg § says that the cholera bacillus grows in 
bouillon, especially in the incubating oven, and in " steril- 
ized milk." An acid reaction of the culture medium pre- 
vents its development as a rule. " It also multipHes itself 
to some extent in sterilized river- and well-water." It pre- 
serves its vitality in sterilized sea-water and multiplies 
there, "but in non-sterilized sea-water it dies out within 
two or three days, the rapidity with which it disappears de- 

* Cholera in Europe and India, Shakespeare. 

t Revue (T Hygiene, 1885. 

X History of Cholera, 1 892. 

\ Medical Record, October i, 1892, 



DIPHTHERIA, 329 

pending upon the number of saprophytes in the water." 
** It dies out in a few days in milk or in river-water which 
contains numerous saprophytic bacteria." " In competition 
with the ordinary putrefactive bacteria the cholera spirillum 
soon disappears," " so it would multiply more rapidly * in 
water not containing a large amount of organic material 
than it would in sewage." 

These experiments with the cholera bacillus in water de- 
stroy what remaining faith there is in such legends as the 
Broad Street pump. They quiet apprehensions that an epi- 
demic can be excited through water which is at a tempera- 
ture below sixty-two degrees, or by a flowing stream, or by 
water which is well supphed with the bacteria which are 
common to it. 

We are forced to one of two beliefs. If we cleave to the 
filth and fecal origin of cholera, we must forsake the germ 
theory. If we hold to the one, we must despise the other ; 
and however great we may conceive our merit to be in 
hurrying to bow down to it, the new idol will not cease to 
repulse our oblations until we have cast down the old. 



CHAPTER XV. 
Diphtheria. 

The filth-origin of this disease was even better estab- 
lished in the minds of the sanitarians than was that of 
cholera or yellow fever or typhoid fever. Like the latter, it 
owes its description and its name to a Frenchman. 

In 1818 t the military legion of La Vendee imported it to 
Tours, a town of twenty thousand inhabitants, where it 

* Sanitarian, October, 1892. f Bretonneau, 1S26. 

28* 



330 VAGARIES OF SANITARY SCIENCE. 

raged for two years. Bretonneau says that it was new to 
most of the physicians of Tours ; he himself had seen only 
two cases of croup. He traces the disease to remote times, 
but says that since the end of the sixteenth century it had 
shown itself in every region of the old and new continents. 
He studied it with great care, made sixty autopsies, and be- 
lieved that it was identical with croup and with scorbutic 
disease of the gums. 

Except to rather lightly touch on its contagiousness, he 
says nothing of its cause. He asks, " May it not be devel- 
oped spontaneously and afterwards transmitted to others ?" 

Guersant, Bouchert, Trousseau, and Empis followed Bre- 
tonneau with their observations. The first two mention no 
cause for the disease. Trousseau * says that when he first 
saw it at Tours, he thought wet and cold might be at least 
exciting causes ; but he was persuaded they were only ac- 
cessories, and was certain it did not depend on seasons or 
.localities or conditions. He saw it in towns which were 
most remarkable for their salubrity, while villages that v/ere 
situated in the midst of marshes were exempt. The habits 
of the people, too, offered no solution for its cause, and 
meteorological influences gave no explanation. 

Empis t says that its etiology is one of its most obscure 
points, and that the different authors who have written 
about it are unable to discover what conditions are most 
favorable for it, and to what influences its visitations are to 
be attributed. 

As with typhoid fever and the other so-called filth-dis- 
eases, the sanitary reformers made no new discoveries in 
the etiology of this disease. They did not even make any 
investigations, but their loquacity was boundless in as- 
cribing it to filth. At first they said it arose from lack of 
sewers. When the sewers were put in, the disease raged 

* 1835. t 1850. 



DIPHTHERIA. 331 

with greater violence than before. They then said the 
sewer-gas caused the disease. The remarkable circum- 
stance about diphtheria is, that in extent and fatality it has 
more than kept pace with the " gigantic strides" of Sanitary 
Science. It was mentioned as a cause of death in connec- 
tion with scarlatina in the registrar-general's report in 1857, 
but did not appear in the list of diseases until 1859. In 
our country, previous to i860, the mortality from it was 
very Hght. In 1866 it caused three hundred and thirty- 
four deaths in New York City. As sanitary laws were 
passed and sanitary regulations were enforced, the mortality 
kept steadily rising, until for the five years ending 1888, the 
average number of deaths yearly from croup and diphtheria 
in New York City was two thousand two hundred and 
eighty-three. This progressive mortality from diphtheria 
in New York is the type of what has been observed re- 
specting it all over the country since the rise of Sanitary 
Science. In spite of these facts, however, none of the 
genuine sanitarians have renounced their faith in its filth- 
origin, neither have they ceased their malicious prosecu- 
tions on the ground that it is purely a filth-disease. In 
1874, Dr. Farr* says, " It is a remarkable fact that of diph- 
theria out of the same number born more die in the healthy 
districts of England than in Liverpool ; the proportions are 
one thousand and twenty-nine in the healthy districts and 
four hundred and forty-two in Liverpool out of one hun- 
dr,ed thousand born." 

In 1876 a severe epidemic of diphtheria visited Salem. 
The Massachusetts Board of Health investigated it. Here, 
not only the inhabitants of uncleanly sections, but families 
whose surroundings were unexceptionable, were attacked. 
Those who inquired into this epidemic report,t " We do not 



* Registrar-General's Report. 

f Massachusetts Board of Health Report, 1S77. 



332 VAGARIES OF SANITARY SCIENCE, 

find the source of diphtheria in filth and insufificient sewer- 
age." It occurred in Lynn, the same year, and not infrequently 
under the most favorable hygienic surroundings. Its favor- 
ite haunts in Lowell were in low and filthy localities, though 
many of these were exempt, and it happened also in high 
and healthy places. The Massachusetts Board says that 
the opinions of physicians agree that the causes of diph- 
theria are, in part, " telluric or meteorological, and at pres- 
ent unknown." It adds that it may be fairly questioned 
whether " the great attention now given to filth-diseases and 
drainage, important as they are, does not often mislead 
people into overlooking other and potent sources of ill- 
health." 

The report says that there are few better-drained places 
than Denis ; yet diphtheria prevailed there for ten or twelve 
months. The physician at Easton writes that he is satisfied 
it is not a filth-disease. In Fitchburg it appeared under all 
conditions, "where there are sewers and where there are 
none, where it is high and where it is low, where it is wet 
and where it is dry. No portion has been exempt." In 
Haverhill and Hanover nothing could be found to account 
for it, with the exception of one case. In Holyoke it was 
most fatal in what, from its topography, seemed to be a 
healthy location. It prevailed in Northfield, where "the 
hygienic surroundings of nearly every house were as good 
as could be asked for." In Waltham, " the dirtiest parts of 
our town have had the fewest cases." There was a scathing 
epidemic in Gloucester in 1876. The report said that it had 
" been most prevalent and fatal in the lowest, worst-drained, 
and most filthy parts of the city, where the most improvident 
and poorest classes are obliged to live ;" but some " of the 
worst and most overcrowded localities have often escaped 
almost entirely, while many houses have been invaded where 
the sanitary conditions were the most favorable in the city." 
At Littleton, " all cases occurred in dry, sunny, good houses 



DIPHTHERIA. 333 

and with well-to-do families ;" and at Maiden it prevailed on 
a hill where was " a fine natural drainage." At Natick it 
"was as often fatal in a high, airy, sunny locality as in 
a low hovel." In Clinton it prevailed equally in good and 
bad surroundings. 

The Massachusetts Board, in summing up the evidence, 
says that " the special connection between this disease and 
filth is not so clearly made out;" and that there is an 
unknown atmospheric condition which, if not necessary, is 
at least important, to produce diphtheria. In 1878* the 
disease prevailed in Ayer, in the best class of houses as well 
as. in the poorest ; on high, low, sandy, pine, and oak land ; 
and was as fatal in one locality as in another. In Haverhill 
it raged the whole year. " The highest and driest neighbor- 
hoods have been visited, while low and filthy localities have 
escaped. In Holyoke, this year, the diphtheria was most 
prevalent in the highest, driest, and best-drained localities." 
The physician who reports from Rockport says, "I do not 
believe that filth or unsanitary surroundings have any other 
influence than by lowering the vitality." In Southbridge 
none of the cases could be clearly traced to local causes. It 
has not been possible to discover any cause for the disease 
at Ware. The physician in North Adams " cannot find the 
causes that develop diphtheria." One fact is established, — 
"that high elevations are more subject to it and with greater 
fatality. In Adams the mansion is no more exempt than 
the hovel." In Berkeley, " the hygienic surroundings where 
it has occurred are as favorable to health as those where the 
disease has not prevailed." In Manchester it was among 
the better class of people, and rarely among those who were 
uncleanly. 

The Massachusetts Report for 1 879 relates that diphtheria 
occurred at Winchester in seventy-two different places. 

* Massachusetts Board of Health Report. 



334 VAGARIES OF SANITARY SCIENCE. 

Sixty of these were carefully examined, and no unsanitary 
condition was found. In two cases the ground-water was 
complained of; in two others slops were thrown on the 
surface. In Orleans it was ascribed to picking over rotten 
potatoes. In Haverhill, this year, it prevailed in the most 
airy and healthy localities, while the densely-populated 
portions are exempt. In 1878-79 diphtheria was unusually 
destructive in Boston. The commission that reported on it 
say,* " The greatest number of deaths was in East Boston, 
a section not noted for unwholesome local conditions ; much 
of the territoiy is high land, well drained, and occupied by 
a thrifty class of people." District Nineteen is rural in 
character, and presents apparently salubrious features. It 
has a death-rate from diphtheria greater than the city at 
large. In District Four, which " has for many years been 
synonymous w4th bad material and moral conditions," the 
inhabitants had a comparative immunity from diphtheria. 
The next section, District Five, a location formerly a mill- 
pond and now poorly sewered, is settled by poor people 
crowded in tenements. " In this insalubrious territory, pre- 
senting in its filth and in its compact population just the con- 
ditions for the spread of a miasmatic, infectious epidemic, 
the death-rate was lower from diphtheria than in any other 
portion of the city, — an anomaly most difficult to explain." 
A careful examination of every dwelling was made by an 
inspector, " especially chosen for his fitness," who reported 
that forty-seven per cent, of the premises " presented nothing 
objectionable." In thirty-nine per cent, the drainage was 
defective; in three per cent, the cellars and yards were 
dirty ; in the remaining eleven per cent, sunken lots, stag- 
nant water, and filthy dumps were observed. The com- 
mittee say, " It is then our duty, in view of the concurrent 



* Boston Medical and Surgical Journal, May 22, 1879. 



DIPHTHERIA. 335 

testimony, to reject the idea that filth fosters the origin and 
dissemination of diphtheria." 

The Massachusetts Board * reports an epidemic at Taun- 
ton. " Every house in which the disease occurred was 
visited again and again, to discover if any local conditions 
could be the cause, but none were found." In West Fal- 
mouth was an epidemic : the " cause appeared to be a too 
free communication between the sick and the well." At 
Maynard it was undoubtedly due to filth, because " many 
wells must be in close proximity to vaults and cesspools," 
though there is no record that any examination discovered 
this condition. 

In the Medical Record, vol. xii., is an account of an epi- 
demic at Burlington, Vermont. Drs. Calderwood and 
Thayer, assisted by Dr. Bowditch, of Boston, spent a 
number of days investigating it, " but without avail, no 
assignable cause being found." Dr. Conleyf writes that 
his village and surrounding country have just passed 
through the worst epidemic ever known there. After a 
careful study of the disease, he is convinced that the cause 
cannot be found in the effluvia of decaying animal and 
vegetable matter, conveyed either through air or water. 

The New York State Board of Health reports diphtheria 
occurring, " aided by polluted wells and foulness of dwell- 
ings, and yet in numerous other cases invading the most 
salubrious homesteads." It is at Benson, a straggling 
hamlet ; " the region is high and well drained." At Chau- 
tauqua it occurred on the most elevated ground. At Indian 
Lake and other places in the Adirondacks, Dr. Curtis said 
that no local cause could be found ; " but it was said" that 
the surroundings at the school-house were unhealthy. 
Sandy Hill was invaded. It lies along the margin of an 
abrupt elevation ; has wide, cleanly streets, houses well 

* 1884. + Medical Record, vol. xix. 



33^ VAGARIES OF SANITARY SCIENCE, 

built, in neat and roomy yards. Few houses have cess- 
pools, and the slops are thrown on the ground. Dr. Curtis 
ascribes some cases here to polluted water. There is no 
report that any of the water was tested ; but he says, *' It is . 
well known that polluted water is often used with impunity 
for a long time, and then suddenly becomes operative in 
producing diphtheria. The causes for this are not alto- 
gether clear." Dr. Curtis * reports the disease at Walden. 
Here he finds in the yards a privy, well, and cesspool, — 
" established data to work upon. Given these," he says, 
"and we have defiled water, defiled air drawn into the 
houses, and diphtheria." Dr. Curtis f investigated the 
diphtheria at Moravia. Here was an uncleanly cheese- 
factory ; and he remarks that the relation of bad sanitation 
to this disease is too well known to need comment. " Its 
germs perish in a clean place, and thrive in a filthy one." 
He found it at Nassau, " on an elevated site ;" but there are 
privies and cesspools here. The sanitary conditions are 
bad, though no worse than they have always been, nor worse 
than are found in many " or perhaps most other villages." 
" Here are facts," says our philosophic sanitarian, " very 
instructive and interesting to the student of disease." Its 
continued existence in Nassau is due to " failure to properly 
destroy the disease-germs, and to accumulations of filth, 
where we know these germs grow most actively, and even 
perhaps may develop de novo." 

The fifth report of the Michigan Board of Health says 
that diphtheria prevails at Lansing, on account of low water 
in the wells. Dr. Conner writes that he does not know how 
to trace the disease in Detroit. At Port Sanders it is not 
due to any want of sanitary precaution. At Lapeer, Man- 
istee, and Kalamazoo it could not be traced to unsanitary 

* New York State Board of Health, 1886. 

f Eighth Report New York State Board of Health. 



DIPHTHERIA. 337 

conditions. At Monroe it is attributed to " lake influence." 
Dn Caulkins, of Thornville, writes that it is more difficult 
to find the cause of diphtheria than that of any other 
disease. At Grand Rapids, Dr. Griswold could gain noth- 
ing reliable to show that bad hygiene was the cause. At 
Hastings "the most cases have occurred in families pos- 
sessing the best sanitary condition in the city." At Albion 
the sanitary condition of all the houses where diphtheria 
occurred was good. It broke out at Sturgis, but the sani- 
tary condition was excellent. At Ann Arbor it prevailed 
under good hygienic conditions. In Kent County the cause 
could not be traced. 

The seventh report of the Michigan Board of Health 
names ten places where diphtheria has occurred, and de- 
clares seven of these towns to be in good sanitary condition. 

The ninth report of the Michigan Board of Health relates 
that diphtheria occurred in the deaf and dumb asylum. 
There were one hundred and thirteen cases. It broke out 
in different rooms ; " nor could any existing cause be de- 
tected in or about the building." 

The eleventh report says that the disease occurred in the 
asylum for the insane, but there were no sanitary defects. 
The thirteenth report says diphtheria has prevailed in Mich- 
igan for twenty-five years. Seventy reporters this year say 
that the mode of introduction of the disease is unknown. 
One hundred and forty-nine attempt to trace it to a pre- 
vious case, or to assign a local cause. The board says that 
some of the opinions expressed are conjectural. Then 
follows a list of causes; among them are dampness, impure 
water, filth, decaying vegetables, decaying log-house, wash- 
ing sheep, an open well, threshing musty wheat, overflowed 
land, etc. 

The New Hampshire Board of Health * say that diph- 

* Third Report. 
V w 29 



338 VAGARIES OF SANITARY SCIENCE. 

theria " is one of the worst types of filth-disease known to 
civilization." Twenty-nine doctors who report on it that 
year mention no cause. Twenty-six say they could not 
trace the cause. Three are particular to say the sanitary 
condition was good where diphtheria occurred. A good 
many mention contagion as the only cause. Four ascribe 
it to polluted water. Twenty-one say " bad sanitary condi- 
tion." Others give a variety of causes, — as cold, a swamp, 
a bad drain, etc. Dr. Fowler, of Bristol, thinks, " Possibly 
it may be of divine origin, as a reminder of our short- 
comings." Dr. Blaisdel could not trace a single case to bad 
sanitary conditions. Dr. Hill reports forty-one cases ; he 
had " not been able to trace a single case to bad sanitary 
conditions." Dr. Davis had " never been able to trace this 
disease to any cause." Dr. Chase said his cases could not 
possibly be from bad sanitary conditions. Dr. Pierce's cases 
were all where the best sanitary conditions prevailed. 

The fourth report of the New Hampshire Board presents 
a similar account of diphtheria. Dr. Chase believes it exists 
independent of filth. Dr. Kimball says, " It is too much to 
ask what is the most common cause of the disease." 

In the first report of the Connecticut Board of Health 
diphtheria is reported at Winsted ; " the cases were on high 
ground and clean surroundings." It occurred in Norwich 
in a healthy locality. Dr. Brown son * reports a severe and 
extensive epidemic in New Canaan. " In the first cases no 
cause for the outbreak could be found ; the disease broke 
out in one of the most salubrious localities in the town." It 
was exceedingly fatal " in some families where the hygienic 
surroundings were all that could be desired." In the Con- 
necticut report for 1888 are the replies of physicians to a 
question concerning the cause of diphtheria. Seventy who 
allude to the disease make no reply to the question as to 

* Connecticut Board of Health Report, 1886. 



DIPHTHERIA. 339 

the cause. Twenty-five said that the sanitary condition 
where it occurred was neither good nor bad ; three said it 
was defective; fourteen said it was good; thirteen said 
good in some cases and bad in others ; five said it was fair. 
Dr. Campbell writes that there was no clew to its propaga- 
tion. Dr. Frost said that in Waterbury it had no reference 
to sanitary condition. Dr. Paddock said that in Norwich 
the sanitary condition was, in many cases, perfect. The 
secretary of the Connecticut Board of Health * investigated 
an epidemic of diphtheria at the Fairfield County Orphans' 
Home. '* A very careful inspection of the whole premises 
was made, both of house and surroundings ; the most 
scrupulous cleanliness was found to exist in every part. 
No explanation of the cause of the disease could be dis- 
covered." The cases were isolated, the premises were care- 
fully disinfected and fumigated, yet in a few days after the 
disease broke out anew in the same building. 

In the Connecticut report for 1890 thirty-nine physicians 
report the sanitary condition to be good where diphtheria 
occurred. Twenty-six say the sanitary condition was bad. 
One says it was " perfect" in some cases and bad in others. 
Some said it happened under all conditions. Bad plumbing 
is mentioned as a cause in three cases, a bad well in one 
case, and a bin where were rotten potatoes in another. 

The same board's report for 189 1 gives the result of an 
inquiry among physicians for the cause of diphtheria. 
Sixty-eight made no reply to the question if any cause 
could be found. Twenty-six said plainly there was no 
cause. The sanitary condition was good — in some cases 
noted perfect — in twenty-one instances; it was bad in 
twenty, and sometimes good and sometimes bad in seven- 
teen cases. Among the unsanitary cases were mentioned a 
filthy hen-roost, a bad well, a cesspool, a broken pipe, etc. 



1S89. 



340 VAGARIES OF SANITARY SCIENCE. 

The Minnesota Board of Health * sent a circular to 
physicians in that State inquiring the cause of diphtheria, 
and requesting a report of the sanitary condition of places 
where it occurred. There were two hundred and twenty 
replies. The condition was stated in only twenty-six in- 
stances. Eleven of these were reported good, ten were 
bad, and five good and bad. Diphtheria had prevailed ex- 
tensively in Minnesota for ten years, and the State Board 
of Health had been wrestling to find the source. It caused 
forty-two deaths in that State in 1872, and the mortality 
rapidly increased until, in 188 1, there were thirteen hundred 
and ninety-seven deaths reported from diphtheria. The 
Minnesota Board of Health seems in despair regarding its 
origin, for at a meeting of the American Public Health As- 
sociation, Dr. Hand,t the president of the board, offered the 
following resolution, which was duly passed : " That as we 
know little or nothing of the origin of diphtheria, we request 
the National Board of Health to continue their investiga- 
tions as to the causes of the disease." In the Minnesota 
report for 1883-84, it is related that diphtheria occurred in 
thirty-two places ; only one reports a bad sanitary condition 
as the cause. 

In Ohio, Dr. HuttJ reports diphtheria at Waverly, where 
it prevailed among all classes. " Those who prided them- 
selves on keeping their premises scrupulously clean were 
no more fortunate than those who did not. The home- 
comforts of the majority were all that could be desired." 
The Ohio Board § received two hundred and eleven replies 
to the query for the origin of diphtheria. One hundred 
and nineteen say the origin is unknown, or that there was 
no known exposure. Eighty-eight report the sanitary sur- 



* Report, 1879-80. 

f Minnesota Board of Health Report, 1879-80. 

% Board of Health Report, 1886. g 1887-88. 



DIPHTHERIA. 34 1 

roundings good, sixty-two bad or not good, and thirty-nine 
fair. 

The California Board of Health * inquired of the physi- 
cians in the State whether diphtheria could be traced to 
local causes, bad sewerage, etc. Seventeen replied that they 
could not trace it, in their practice, to local causes, filth, or 
sanitary surroundings. One traced it to impure water, two 
to imperfect sewerage, one to a slaughter-house. One 
physician wrote that it had no respect for condition in life. 
Dr. Smith said that in Cloverdale it raged most virulently 
where everything seemed most conducive to health. Another 
doctor writes that it has shown no preference for unhealthy 
localities. Another says, " Strict inquiry failed to develop 
any unsanitaiy condition." Another says, '* It attacked the 
cleanly as well as the filthy ; it had no respect for person or 
place." The California Board expresses official surprise 
because so many declare that no cause can be found in un- 
sanitary surroundings, " in view of the strong ground taken 
on this subject by the leading sanitarians of the world." 
The secretary of the board reinforces " the leading sanitari- 
ans of the world" by saying that, while he has been writing 
the report, some diphtheria has been brought to his notice, 
where, within eighty yards of the house, there is a drainage 
canal and an enclosure for ducks and chickens which is 
quite filthy ! 

Dr. Earle, of Chicago,t investigated this disease through 
correspondents in the extreme Northwest. He found that 
it prevailed in the mountains and prairies, where were the 
purest air, the purest water, and the purest soil, with the 
same malignancy that it did in the cities. One physician 
reports to him that the worst diphtheria he ever saw was in 
a habitation upon sandy soil, in the hills, fifteen miles from 
any point of infection. 

* 1878-79. t 1888. 

29* 



342 VAGARIES OF SANITARY SCIENCE, 

An official report of the examination of premises m 
Boston,* where one thousand and twenty-one cases of diph- 
theria occurred, showed that five hundred and thirty-four 
of the houses were in bad sanitary condition and three 
hundred and ninety-three in good sanitary condition. A 
column of ninety-four is given under the head of " not ex- 
amined." If we assume that no examination of these was 
made because the board knew they were in good condition, 
and add them to those reported in good sanitary condition, 
we have four hundred and eighty-seven houses in Boston 
in good sanitary condition where diphtheria occurred, 
against five hundred and thirty-four in bad sanitary condi- 
tion. It is not unfair to presume that many of those living 
in houses reported in bad sanitary condition were poor and 
destitute and overcrowded, and that contagion was an im- 
portant factor. In 1888, of twelve hundred and thirty-two 
houses examined in Boston, where diphtheria occurred, five 
hundred and ninety-six were in bad sanitary condition and 
five hundred and twenty-one in good sanitary condition. 
No examination was made in one hundred and fifteen cases. 
At Boston, in 1889, of fifteen hundred and fifty-two houses 
which were examined, where diphtheria happened, seven 
hundred and seventy were found in good sanitary condition 
and seven hundred and eighty-two in bad sanitary condi- 
tion. In 1890, in the same city, the premises where diph- 
theria occurred were found to be in good sanitary condition 
in six hundred and twenty two instances and in defective 
sanitary condition in six hundred and nineteen cases. 

That medical men in France are no more certain of the 
causes of diphtheria than they were when Bretonneau and 
Trousseau investigated the disease, is shown by the fact 
that at a sitting of the Societe de Medecine Pubhque, May 
23, i888,t M. M. Brouardel and Dr. Du Mesnil asked that 

* Report of Boston Board of Health, 1887. f Revue d' Hygiene. 



DIPHTHERIA. 343 

a commission be appointed to inquire into the causes of 
diphtheria. The reason they give for making this request 
is that " there is no epidemic disease of which we have less 
knowledge as regards its propagation." 

The English sanitarians, who for thirty years have been 
trusting to the " slightest inspection" and to the " moment's 
thought," to designate the cause of this disease, as they did 
for the fever at Wolverhampton and other places, have as- 
cribed it at one time to want of sewers, and then to the 
presence of sewers, to filth in general, to milk, and, when 
these failed, to cats and to poultry. They now find it 
breaking out in 1 891 * at Salford, where the sanitary' condi- 
tion is perfect, the milk pure, the cats and poultry in 
sound health, — for it is distinctly stated that no sickness 
prevails among the domestic animals, — and these Eminent 
Sanitarians concur with the medical officer at Salford in 
the belief that ** the necessity for an exhaustive inquiry as 
to the origin and maintenance of diphtheria in this country 
is growing daily and has already become a matter of daily 
concern." It bursts out in St. Bartholomew's Hospital.f 
The drainage is accused ; but the medical and surgical staff 
assert that this is in good condition, and that the cause for 
the outbreak is unknown. Dr. Alfred Carpenter J stated 
that fifty years ago it was unknown, but year by year it had 
steadily increased, and that the carrying out of sanitary 
measures " had failed in the case of diphtheria." Dr. R. 
Thorne, in the Morley Lectures on Diphtheria, notices its 
increase in London and the large cities, the number of cases 
having nearly doubled in ten years, and he remarks that 
this calls " for a searching inquiry into the natural history 
of the disease, especially as regards its causation and pre- 
vention." At the International Congress of Hygiene in 

* London Lancet. f Ibid., April, 1S91. 

% British Medical Journal , September, 1S91. 



344 VAGARIES OF SANITARY SCIENCE. 

London (1891), as the result of a discussion of the causes 
of diphtheria, the sanitarians in their despair offered a reso- 
lution, which was passed, that " European governments 
should make a comprehensive and systematic inquiry into 
the causes of diphtheria." 

The causes of epidemic and infectious diseases have long 
engrossed the anxious thought of medical men in general ; 
and in seeking for the causes of such diseases every realm 
in nature has been thoroughly explored by the most pene- 
trating minds in the profession ; and since they all openly 
confess or tacitly admit that the causes are unknown, and 
since they are acknowledged to be men of keen perception 
and sound judgment, we need not apologize for our lack of 
confidence in those other men who have organized them- 
selves into a sanitary hierarchy, and who profess to have 
discovered the why and wherefore of infectious and epidemic 
diseases, and to know the causes thereof as exactly as we 
know the causes of railway accidents. 

To be sure, the sanitarians are, as a body, far more con- 
spicuous than the physicians, and vastly more arrogant and 
dictatorial. They perambulate, at public expense, from one 
sanitary convention to another, — each man saluting his 
fellow as "the Eminent Sanitarian." They concoct and 
ripen panics about the public health ; they usurp the func- 
tions of the attending physician ; they dictate offensive 
legislation ; they call for heavy fines and even imprisonment 
upon those who transgress their sanitary codes ; and, impa- 
tient of the slow course of the law, they recommend, as we 
have seen on page 27, mobbings, hangings, and burnings. 
But not one of them ever made a discovery of any conse- 
quence, or even any investigation that merits the epithet 
scientific ; and in attempting to solve profound and intricate 
problems affecting the welfare of the whole human race, 
they have put forth the most puerile theories and proclaimed 
the most ridiculous conclusions. 



EPIDEMICS. 345 

We respectfully submit to medical men the question, 
whether it is not inconsistent with the dignity of their pro- 
fession, and with the duty which they owe to their fellow- 
men, that they shall longer tolerate by their silence such 
charlatanry. 



CHAPTER XVI. 
Epidemics. 

The history of epidemic disease is coeval with the history 
of mankind. The obscurity which surrounds the causes of 
its appearance is as dense as it was six thousand years ago. 
Too vain to avow their ignorance, the ancient wise men pre- 
tended to discern its origin in the movements of the heavenly 
bodies. Spiritual and devout men, who felt oppressed with 
the burden of their own sins or the sins of others, recog- 
nized in such diseases the righteous power of an offended 
Deity. 

Diemerbrock * says the particular causes of plague are 
very intricate. It comes by divine appointment as a just 
punishment for our national sins ; but, secondarily, it pro- 
ceeds from some secret, malignant, and virulent seeds, con- 
sisting of very subtle and volatile particles which disperse 
their contagion through the atmosphere. Dr. Nathan 
Hodges f says the plague is " an aura that is poisonous, 
very subtle, deadly, and contagious, chiefly arising from 
a consumption of the nitrous spirit of the air." Von Hel- 
mont says that the remote, crude, and first occasional matter 
of the pestilence is an air putrefied through continuance; or, 
rather, a hoary, putrefied gas, which putrefaction of the air 
hath not the eight-two-hundredths part of its seminal body. 

* Stanton's Translation. f London, 1665. 



346 VAGARIES OF SANITARY SCIENCE. 

Dr. Mead said that the plague was due to the putrefaction 
of animal substances in the East, but that no kind of putre- 
faction can produce it in Europe. 

If we compare these definitions of the causes of epidemics 
in early with those of later times, we find that they do not 
differ at all in substance, and not very much in language, 
from those given by the modern sanitarian. Although the 
latter affects to have emancipated himself from the super- 
stitions of the past, and to despise the beHef in divine medi- 
ation in the production of pestilence, he has no better theory 
to offer for its appearance. He talks learnedly of the " septic 
ferment," the " morbific principle," and the " mephitic gases" 
as the active agents in causing disease ; but there is no more 
proof of their existence than Von Helmont had of his "hoary, 
pestilential gas," or Diemerbrock of his " secret, malignant, 
and virulent seeds." Admitting all that is claimed at the 
present day for the germ-theory of disease ; that in reality it 
is proved beyond a doubt ; and, as if this were not enough, 
admitting the more delicate hypothesis of the influence of 
the ptomain which, we are told, is generated by the germ, 
and we still have no explanation of epidemics. It is still 
hidden why the germ should be so rampant or the ptomain 
so energetic in one year as to destroy millions of people, 
and then suffer a condition of atony and quiescence for a 
centur>% and perhaps disappear altogether. 

Most, if not all, of the ruinous epidemics which appeared 
before the eighteenth century were said to have been pre- 
ceded, or followed by, or accompanied with, great celestial, 
meteorological, or telluric disturbances, — meteors, comets, 
eclipses, tornadoes, extreme cold, stifling heat, drought, 
floods, earthquakes, and volcanic eruptions. The great 
pestilence which swept over Europe in the fourteenth cen- 
tury was heralded, Boccaccio says, by an unfortunate con- 
junction of planets, with Saturn in the ascendant; and the 
astrologers therefore predicted great calamities to mankind. 



EPIDEMICS. 347 

Boccaccio was not certain whether the plague at Florence 
was caused by this unhappy meeting of the heavenly bodies, 
or whether it arose from our iniquities, for which a just God 
was about to punish us. Ample warning was given of its 
approach. Wise sanitarians held much counsel, and pub- 
hshed instructions for preserving health. Many religious pro- 
cessions were made, and prayers were offered to placate an 
angry God. All filth was removed, and all suspected people 
were denied access to the city. Those who were sick were 
closely confined to their houses. No human endeavors, 
however, could stay its progress. This particular epidemic, 
of a disease which had been known for nearly thirty cen- 
turies,* took its rise in Cathay in 1346, swept over India 
and Turkey, penetrated Egypt, and appeared in Sicily in 

1347. 

In 1348 it arrived in Florence, where it spread like fire 
among tinder, and carried off one hundred thousand of the 
inhabitants. No medical aid vanquished its symptoms. To 
talk with one afflicted, or to touch his body or clothing, 
would communicate the distemper. It seized the inferior 
animals also. Boccaccio saw two swine rooting among the 
clothing of a patient which had been thrown in the street. 
The animals were attacked and died in a few hours. 

To avoid the pestilence, some people went on shipboard 
and sailed out to sea ; some shut themselves up in their 
houses and lived in the most abstemious manner; some 
moved about from tavern to tavern, eating and drinking 
freely, singing, joking, and laughing. Others took a middle 
course, living temperately, and following their usual occu- 
pations ; but the pestilence smote alike the fugitives, the 
over-cautious, the reckless, and the temperate. Human 
affections and human laws were set aside ; citizens and 
friends distrusted each other; husbands and wives deserted 

* Papon, «*De la Peste." 



343 VAGARIES OF SANITARY SCIENCE. 

their homes and separated ; sisters and brothers no more 
recognized the family relation; children forsook their 
parents, and, says Boccaccio, worse than all, parents aban- 
doned their children.* 

In 1 348 t there appeared in Paris, towards the west, says 
an old chronicler, a great and clear star, which seemed 
nearer the earth than other stars; it separated into many 
divergent rays and disappeared. It was thought to be the 
presage of the terrible scourge that was approaching to 
desolate France the next year. During the winter of 1347- 
48 the pestilence progressed slowly, but in the spring it 
took on a frightful energy. Three-fourths of the people of 
Avignon succumbed to it; Narbonne was depeopled; in 
some places in Languedoc and Provence only a tenth of the 
inhabitants were spared. Petrarch's Laura was one of the 
victims. It advanced from town to town, sparing neither 
age nor sex. 

In 1349-50 it overran Germany and England. It is esti- 
mated that in four years one-half of the inhabitants of 
Europe were swept away. In London % fifty thousand were 
buried in one graveyard ; one hundred thousand died in 
Venice ; Lubec lost ninety thousand of its people. It extin- 
guished the colony of Danes in Greenland. It behaved 
sometimes in a most capricious manner. Here and there 
portions of the country, like Milan and Brabant, escaped 
entirely. 

In London, in order to control the pestilence, dwellings 
were searched, slaughter-houses were suppressed, stink-pots 
were burned in the squares, cannons were fired, church-bells 
were tolled, and the streets were filled with the fumes of tar, 
brimstone, and vinegar. It is interesting to notice that, 



* II Decameron, Introduzione. 

f Histoire de France, H. Martin, vol. v. 

X Brooke's History of Pestilence in London, 1772. 



EPIDEMICS. 349 

except tolling of church-bells, these same prophylactic 
measures were, adopted by the sanitarians in Jacksonville 
during the epidemic of yellow fever in 1888. 

There were sanitary experts in France in the fourteenth 
century, and some of them discovered the cause of the pes- 
tilence in the atrocious designs of the Jews, who, rumor 
said, had poisoned the wells. They were arrested in great 
numbers and put to the question. In their spasms of torture 
they confessed the crime and implicated others. Wholesale 
convictions were the result, and the robbing, hanging, and 
burning of thousands followed. But the obstinacy of the 
race was never more conspicuous. The Jewish women had 
witnessed, in mute despair or silent rage, the torture and 
burning of husbands and brothers ; but when the Christians 
laid hands on their children to baptize them, the Hebrew 
mothers tossed them into the flames and leaped after them 
in triumph. 

When the pestilence had passed, men and women married 
a Venvi; women conceived beyond measure; none were 
sterile ; everywhere were femmes enceintes, and many gave 
birth to two and even three living children. The world 
was, in a way, renewed, and there became a new age. " But, 
alas !" says the historian, " this renovation brought no per- 
manent betterment to mankind ; for men only became more 
avaricious, and peace was established neither in State nor 
Church." * 

Fifteen years later, in 1362, the plague repeated its visits; 
and now it seemed to avoid the cities, and raged in moun- 
tainous districts where the air was admitted to be pure. 
For three hundred years this particular plague made the 
tour of Europe at irregular intervals. In the seventeenth 
century there were more than fifty epidemics of the disease 
in the different states in Europe. Between 1500 and 153a 

* Histoire de France, H. Martin, vol. v, 
30 



350 VAGARIES OF SANITARY SCIENCE. 

it ravaged Switzerland and decimated Geneva. M. Mallet * 
tells us that he found some curious records of the plague in 
that city. The sanitarians of that day had their sanitary 
codes; and, notwithstanding that the reformers of our times 
boast of the " gigantic strides" of Sanitary Science in the 
care of epidemics, the precautions now taken are almost 
precisely the same as those used three hundred years ago. 
They consisted then in a pest-hospital, and in the pretended 
disinfection of the houses containing the sick or the dead. 
In those days the trust in fumigations was as deeply 
grounded as it is at the present time, and the process was 
probably as efficacious then as now. The Board of Health 
convened every day. It forbade convalescents to go abroad, 
unless they were attended by a guide ; at home it compelled 
them to close their windows, except at night. Assemblies 
of people were forbidden ; no one was allowed to bring fresh 
fruits to market. The schools were closed. Heads of fam- 
ilies could not leave the city, and none but children and 
pregnant women could stroll in the fields. Mallet says that 
it is difficult to conceive the benefit of this regulation re- 
specting the heads of famiHes, for it only concentrated the 
people and increased the misery. Privies and stables were 
supervised, and all nuisances were removed ; pigs and geese 
were banished from the town. In 1568 the Board of Health 
at Geneva issued an order to kill all the cats and dogs in 
the city. Aromatic woods were burned in the streets, and 
preservatives of all kinds were in the drug-shops, at the 
pleasure of the public. In 1530 it was pretended that a 
plot was discovered which showed that the hospital author- 
ities were engaged in spreading the pestilence. The sup- 
posed author of the plot, Caddoz, at first denied all knowl- 
edge of it ; but, when put to the torture, he confessed his 
own guilt and accused others. All were hanged, drawn, 

* Notice sur les Anciennes Pestes de Geneve. 



EPIDEMICS. 351 

and quartered. The sanitarians had a convincing proof 
that this "aggressive sanitation" was efficacious; for the 
historian says, " Immediately after, the plague ceased." 

"Aggressive sanitation" worked so well in 1530 that, when 
the pestilence reappeared in Geneva in 1545, it was tried 
again. A new plot to spread the disease was discovered. 
The supposed authors at first denied all complicity, but 
under the torture confessed; and seven men and twenty- 
four women were burned alive. The surgeon and the enter- 
reur of the hospital had a worse fate. In 1568 they were 
still burning, in Geneva, the spreaders of the pestilence. 
Mallet, in commenting in 1835 on these transactions, says 
that in Paris, in 1832, during the cholera, an insensate mob 
tore to pieces some people who were suspected of being 
enemies of the public health.* 

In 1576 the plague raged through Northern Italy, attack- 
ing some cities and leaving others untouched. It puzzled 
the doctors in those days to find out why Padua and Verona 
should be swept by it, and Vicenza, which lay directly on 
the road between them, should escape. In 1603 it carried 
off two thousand people daily in Paris. The disease here 
was ascribed to the filth. Mr. Webster, sagacious man that 
he was, confesses his inability to comprehend " why the filth 
in Paris did not produce the plague in other seasons." 
Whether it was this or some other epidemic which desolated 
the American shores before the landing of the Pilgrims, it 
is impossible to determine ; but Captain Dennan, an English 
sailor who cruised along the northern coasts in 1619, found 
whole Indian villages destroyed, which the year before were 
populous. Nearly all of the people had died from some 
pestilence. 

The plague subsided after 1665. It was not seen in Eng- 
land after that year, and soon ceased to afflict the Continent, 

* See note at end of chapter. 



352 VAGARIES OF SANITARY SCIENCE. 

until, in 1720, it again broke out at Marseilles. Its disap- 
pearance from England in 1665 was ascribed by the sani- 
tarians of that day to the great fire in London, and the 
subsequent rebuilding of the city, when the streets were 
broadened and made more airy. Mr. Webster is a little 
incredulous on this point, for he cannot see how the great 
fire in London should cause the entire abatement of the 
plague in Germany, France, and Spain. 

De Foe * says that his " friend. Dr. Heath," was of the 
opinion that the plague might be known by the smell of 
the breath. " It was the opinion of others that it might be 
distinguished by the party's breathing upon a piece of glass, 
where, the breath condensing, there might living creatures 
be seen by a microscope, of strange, monstrous, and frightful 
shape, such as dragons, snakes, serpents, and devils horrible 
to behold." De Foe himself, however, questions the truth 
of this, for he says that there were no microscopes at that 
time with which to make the experiment. 

The plague visited Milan in 1630. In "I promessi Sposi," 
Manzoni gives, probably, as truthful an account of this epi- 
demic as can anywhere be found. Just how it arose was the 
subject of much dispute ; indeed, there is hardly an epidemic 
on record the rise of which has not been the subject of more 
or less disagreement, and often of wrathful altercation, be- 
tween the contagionists and the non-contagionists. The 
usual sanitary measures which were in vogue were adopted 
in Milan. Houses were fumigated, the bedding and clothing 
of the dead and convalescent were burned, dwellings were 
closed, and the sick were removed to pest-hospitals. None 
of these means offered the least resistance to the scourge. 
At length the belief sprang up somehow, and rapidly gained 
ground, that certain diabolical arts were practised by be- 
witched persons to spread the disease with venomous oint- 

* Plague of London. 



EPIDEMICS. 353 

ments. In the cathedral a board partition had been oiled. 
This partition and some seats were afterwards taken out and 
placed in the square. The cry was sounded that they had 
been covered with the poisonous grease. The president of 
the Health Council with three officials visited the spot. They 
saw nothing to sustain the foolish report; but instead of 
boldly proclaiming the nonsense, they ordered the partition 
and seats to be scraped and rubbed. This procedure, under- 
taken, no doubt, to quiet apprehension, and to prove the 
caution of the health authorities, made a certainty of what 
was before only a suspicion. The next day there went 
abroad a rumor that would brook no contradiction. It was 
to the effect that houses in all parts of the town had been 
smeared with some yellowish filth, which was surely the 
deadly ointment. It was never known whether this was a 
wild dream, or whether some stupid or malicious person had 
daubed the houses. 

The sanitarians in authority visited them and pretended 
to examine the stains ; they experimented with the stuff on 
dogs without any bad result to the animals, and treated the 
matter as of no consequence. But the story of the venom- 
ous ointment had gained so strong a hold on the public mind 
that the city was in an uproar. The public buildings, the 
chains, the door-knockers, were anointed. The story flew 
from mouth to mouth that the poison of the ointment was 
sudden, keen, penetrating ; it was the venom of toads and 
serpents, and the slaver of patients who had perished from 
the pestilence. If any one smiled incredulously at these 
stories, he was blind to the danger ; if any one denied them, 
he was an enemy of the public health and an accomplice of 
the untores. Foreigners were arrested and brought to judg- 
ment ; if a suspicious-looking person halted on the street, 
he was one of the anointers, seeking a place to smear his 
ointment ; if he walked along, he was disseminating it. The 
remains of San Carlo were now transported through the 

X 30* 



354 VAGARIES OF SANITARY SCIENCE. 

streets of Milan in grand procession, in the hope that they 
might exorcise the evil spirit of pestilence. For a few hours 
a fanatical security possessed the populace ; but in a day or 
two the mortality doubled, and reached three thousand five 
hundred deaths in twenty-four hours. This sudden bound 
in the number of deaths was not ascribed to the crowding 
together of the people in procession, but to the untores, who 
had mingled with the multitude and applied the ointment to 
their clothing. Something must now be done. The sanitary 
authorities were equal to the emergency. However much 
they might doubt these crazy tales, they now issued a decree 
promising reward and immunity to those who would expose 
and denounce the anointers. In the early twilight of the 
morning a maid-servant saw, from a second-story window, a 
man passing along the street. He seemed to be touching 
the walls of the yards and houses. She gave the alarm that 
he was one of the untores, and the whole neighborhood was 
aroused. The people thought that they discerned the oint- 
ment on the walls, so they lighted wisps of straw to burn it 
off, and scrubbed and scraped and whitewashed the walls 
anew. The police were notified ; but when the reputed 
anointer was arrested, he proved to be a sanitary inspector. 
When arraigned, he denied all knowledge of the unction. 
He was put to the question, that he might confess, and divulge 
the names of his accomplices. Even in the most acute 
paroxysms of pain, the unhappy wretch sustained his denials. 
Not until the Tribiinale della Sanitd had promised complete 
immunity did he yield. In a spasm of exquisite torture he 
spoke the name of a poor barber, who, he said, was to receive 
much money from certain persons if he would manufacture 
and spread this ointment. The barber and his family were 
thrown into prison, and their premises were searched by the 
sanitary authorities. Twelve cents in money were found. 
Barrels, bottles, and pots were peered into. At last the 
searchers found that one of the vessels contained some dirty 



EPIDEMICS. 355 

suds, in which was a slimy sediment. The proof was com- 
plete! The barber was indicted, but denied the charge 
against him. Bruised in body by the torture, which was 
applied again and again, and broken in spirit by his confine- 
ment, he accepted the promised immunity, confessed the 
crime, and named his confederates. These in turn were 
arrested, imprisoned, and tortured. Notwithstanding the 
exemption which had been promised, the sanitary inspector 
and the barber were savagely executed with horrible tor- 
ments, protesting in their dying moments their own inno- 
cence, and retracting the charges they had made against 
others. The barber's house was demolished by the author- 
ities, and in its place was erected a column. La Colonna 
Infame, which stood for one hundred and fifty years a 
monument to the ignorance, folly, and wickedness of man- 
kind.* 

The plague appeared as an epidemic for the last time in 
Western Europe in 1720, at Marseilles. The same pre- 
cautions were taken to prevent its approach, and the same 
sanitary measures were taken to subdue it after it arrived ; 
and the same fruitless results followed their execution as 
had succeeded them in previous epidemics. It raged in that 
city for five or six months. The bishop ordered a religious 
procession, and appeared himself as the scapegoat, loaded 
with the sins of the people. Barefooted, with a halter about 
his neck and a cross in his arms, he celebrated a mass before 
the people. As this abasement of clerical dignity had no 
power to abate the sickness, he made an exorcism against 
the plague a few days later. Three days after, it had so in- 
creased in virulence that neither Church nor State sufficed 
to control it. 

The habits and customs of the people of Europe in the 
fourteenth century did not vary, to any great extent, from 

* Storia della Colonna Infame, Manzoni. 



356 VAGARIES OF SANITARY SCIENCE. 

those of the eighteenth. Yet the modern sanitary orators 
of both sexes, lay and clerical, tell us that this wonderful 
dispensation, which held the world in terror for nearly four 
hundred years, was caused by accumulations of filth, which 
reached in Asia and Europe precisely the point of activity 
to develop the pestilence in its greatest virulence in 1346-50. 
Moreover, these collections of filth oscillated at irregular 
intervals, between periods of repose and frightful activity, for 
four centuries, and then suddenly ceased to have the least 
power to produce the plague. With flaming eye, dishevelled 
hair, and frantic gestures, the same orators tell us, in almost 
so many words, that this pestilence, this " Black Death of 
the Middle Ages," will surely reappear, unless we endow 
them with power and furnish them with money to avert the 
calamity. 

The plague broke out again in the East in 1856, and until 
1878 there was much apprehension that it would again 
devastate Europe. Three or four government commissions 
were sent to investigate it. During the twenty years which 
followed its outbreak in 1856 a number of limited epidemics 
occurred. Dr. Tholozan, physician to the Persian Shah, in 
his account of those which arose in 1856, '58, '59, '6y, '74, *'/y, 
says that he has compared the epidemics of plague in those 
countries where sanitary systems were in operation with 
those where the barbarism, ignorance, and fanaticism of the 
populace are opposed to all hygienic measures. " I have 
•shown thus, not without surprise, that the existence or not 
of a sanitary administration has made no difference in the 
intensity, duration, and occurrence of epidemics. We do 
not know, in reality, why these plagues disappear, any more 
than we know why they appear at certain epochs." He 
hopes to render a service to Sanitary Science by giving 
'Occasion for a revision of its methods, removing defects, and 
seeking for more humane, more practical, and more serious 
means of action than have hitherto been taken. 



EPIDEMICS, 357 

Dr. Hirsch, who was one of the German Commission to 
investigate the outbreak of plague in Astrakhan in 1878, 
says that the " suggestion is scarcely worth discussion," 
that it was due to unsanitary condition. While in this re- 
spect there was much to be desired, the sanitary condition 
was in many places much better where it appeared than it 
was in those places which escaped. It was no worse any- 
where than it had been in previous years, yet there had not 
been a trace of plague in that country since 1807. "In- 
deed," he says, " there are many places in Germany and in 
other countries in Europe which are more unwholesome 
than those places which were attacked in Astrakhan." He 
adds that his opinion — namely, that it did not arise from 
local conditions — is held in common with that of other. 
European commissioners who investigated this epidemic. 
Dr. Zuber,* the French commissioner who investigated the 
same plague, says that the disease first broke out at Vet- 
lianka, not in the most uncleanly part of the town, which 
was in a detestable condition, but at the opposite end, 
where the best hygienic conditions prevailed. A dozen of 
the best houses in the town, in which the plague first 
started, were burned. He rejects the idea that it was 
caused by personal uncleanliness, and although the reigning 
belief has become a dogma, that filth generates and fosters 
it, and it is a heresy to deny it, yet if he is asked, " Has the 
epidemic struck uncleanly countries, villages, quarters, 
houses, or people, in preference to cleanly ones ?" he is 
obliged to answer, " No." " The progress of the epidemic 
was independent of the ordinary conditions of age, race, 
profession, or even meteorological and hygienic conditions." 
Dr. Tholozan f says of the disease in Khorassan that it 
broke out in salubrious localities which offered none of the 



* Hygiene Publique. 

f Comptes-Rendus de TAcad^mie des Sciences, 1877-78. 



358 VAGARIES OF SANITARY SCIENCE. 

conditions supposed to be necessary for the development of 
pestilence; the half-nomadic inhabitants living on an open 
plain, or on the sides of mountains, engaged in agriculture 
and grazing, were struck with the disease in its gravest 
forms. Dr. Tholozan studied the plague which prevailed 
for the twelve years ending 1878. He says it can arise and 
rage just as well in dry, elevated, and cold countries as in 
low, wet, and marshy lands ; on the summits of mountains 
as well as at the delta of the Nile ; that, like cholera, diph- 
theria, and typhoid fever, it takes on an epidemic form at 
certain times and places which actual science does not know 
the cause ; neither can it arrest its progress nor hasten its 
decline. Dr. Tholozan * declares his disbelief in the effi- 
cacy of so-called sanitary measures ; that experience has 
proved that no prophylactic means contribute to its disap- 
pearance or decline ; that, like all epidemics, it has its periods 
of spontaneous rise, progress, and abatement, uninfluenced 
by sanitary cordons, quarantine, isolation, disinfection, or 
ventilation ; that it frequently spreads when all these meas- 
ures are carried out with military severity, and that it often 
disappears when none of them are adopted. He concludes 
that no prophylactic measures, however thorough they may 
have been, have ever contributed to the disappearance or 
diminution of plague, and that it, like all other epidemics, 
has its times of invasion and development, of spontaneous 
increase and decline, sometimes slow, sometimes rapid, with 
isolated or multiplied explosions, sometimes grave, some- 
times slight ; but alike uncontrollable, because its cause is 
as unknown as that of the cholera, diphtheria, or small- 
pox. 

Throughout the eighteenth century the people in Europe 
and America suffered from circumscribed epidemics, which 
were quite as mysterious in their origin, arrival, and depart- 

* Les Trois Epidemics de la Peste. 



EPIDEMICS, 359 

ure as was the great pestilence of the Middle Ages. Dys- 
entery, fevers, diphtheria, small-pox, and measles made 
great havoc in town, city, and country. The new world 
suffered equally with the old. The early settlements in 
America were often threatened with destruction by pesti- 
lence. Philadelphia was but seventeen years old — a sparsely- 
settled village — when it was stricken with a scorching epi- 
demic. The earlier historians of New England record, almost 
yearly, epidemical invasions of contagious disease. 

Although the human race suffered local epidemics for the 
hundred years which followed the entire disappearance of 
the plague in Europe, it enjoyed a reprieve from those 
which desolated vast continents, until about the year 1820, 
when the cholera began to advance westward. The sani- 
tarians tell us that it was the filth, and that alone, which in- 
vited it ; we had not done our slaughtering and bone-boiUng 
with sufficient care ; we had neglected to sweep out the 
stables ; the privies were extraordinarily full, and a subter- 
raneous communication had been established between them 
and the wells, and the cesspools had been uncleansed. The 
cholera, therefore, selected 1832, 1849, 1865, and 1873, 
those being the precise years when the filth was in its high- 
est activity — its perihelion — to make its destructive circuits 
of the globe. 

Filth has not failed to account, not only for the world- 
wide epidemics, but for those which were limited to States, 
cities, towns, and small districts, and even for every sporadic 
case of so-called zymotic disease. The sanitarians never 
considered it incumbent on them to explain why the filth 
undulated between violence and repose, why it sometimes 
lay dormant for two centuries, as at Newport and Stamford, 
or why it was quickened into furious activity in a few weeks, 
months, or years, as in California and Colorado. 

But for those wonderful displays of an unknown power, 
which in former centuries, and ev^en as late as the middle of 



360 VAGARIES OF SANITARY SCIENCE. 

our own, threatened to sweep the human race from the face 
of the earth; those terrible scourges which, taking their 
origin in the direction of the rising sun, spread westward 
over the globe, now sparing in their caprice whole provinces 
and cities only to involve these in destruction on the next 
visit; for these awful exhibitions of an invisible energy, 
which made the apostate pause in his unbelief and the de- 
vout man to question whether the Great Disposer of events 
was animated by the spirit of Good or the spirit of Evil ; 
these mysteries the sanitarians offered to solve with reasons 
which were silly enough to exasperate the mind of an idiot : 
they said it was purely a question of scavengering ; we had 
not been quite as squeamish and delicate in performing the 
acts of urination and defecation as we ought to have been, 
and it served us right to be visited, therefore, by these pes- 
tilences. 

The modern sanitarian seems incapable of viewing any- 
thing but filth as the cause of infectious disease, epidemic 
or sporadic. Heredity, race, temperament, sex, age, climate, 
food, raiment, shelter, work, rest, play, wealth, comfort, 
poverty, civil condition, — married or single, — trade, profes- 
sion, habit — all of those circumstances and conditions, 
alterable and unalterable, which the medical practitioner 
considers of such hygienic importance to the well, and 
which he tries to estimate at their full value when called 
to prescribe medicine or regimen for the sick — ^pass for 
naught with our modern sanitarian. It is enough for him 
to know whether the drains have the proper declivity, 
and whether they are trapped, to prevent the backward 
pressure of the " hoary pestilential gas" or the " septic fer- 
ment." 

When the pestilence arrives, he does in Jacksonville in 
1888 as his prototype did in Florence in 1348, and in Lon- 
don in 1665. He musters his forces, invades the houses of 
the citizens, gets out his stink-pots, fires his cannon, fills the 



EPIDEMICS, 361 

air with the fumes of pitch, tar, sulphur, and vinegar ; and 
after the epidemic is spent, he tells us that he has stamped out 
the disease, and he congratulates the people that Sanitary- 
Science has made " gigantic strides." 

For nearly a thousand years we have records, more or 
less obscure, of epidemics of influenza, for the most part 
affecting mankind, but occasionally seizing the inferior ani- 
mals. Although the organs affected both in man and 
animals are the same, and the symptoms almost identical, 
there seems no reason to believe that the disease is mutually 
transmissible. Though the cause of these epidemics in 
man and beast has been the subject of much speculation, it 
has never been explained any more satisfactorily than the 
cause of other infectious diseases. Between the years 1580 
and 1 610 six extensive epidemics of influenza are recorded. 
An interval of repose followed, lasting for nearly forty years, 
until 1647, when the disease again appeared. For the next 
century and a half the longest intermission between any two 
epidemics was five years. 

After an immunity of nearly forty-five years, the disease 
suddenly arose in the Russian dominions in September or 
October of 1889, and moved rapidly westward. M. Leon 
Collin * declared that it travelled on lines independent of 
human transportation, and he compared the velocity of its 
movement to that of light or electricity. It broke out 
simultaneously in two distinct quarters of St. Petersburg, — 
one rich, the other poor and crowded. During its presence 
in that city it is estimated that from one-third to one-half of 
the people were affected by it. By the middle of December 
every European country had been invaded by it. People 
were attacked by it in Boston, December 10, — as early as 
they were in London. It seemed to radiate from Boston to all 
parts of Massachusetts. It spread rapidly all over the United 

* Bulletin de I'Academie de ISIedecine, Paris, 1SS9. 
Q 31 



362 VAGARIES OF SANITARY SCIENCE. 

States. Dr. Lee * says that cases of the disease were seen 
in Pennsylvania as early as November. By January, 1 890, 
it had reached New Mexico and Central America, and later 
in that month it appeared in the Argentine Republic and 
Chili. In the latter country seventy per cent, of the popu- 
lation were affected by it. Neither season, nor climate, nor 
weather had any influence on it; prevailing winds offered no 
impediment to its progress. The next year it reappeared, 
sometimes raging with greater severity in the same localities 
which had suffered the previous season, sometimes striking 
with a double force those which had hitherto escaped. 

In this epidemic the professional sanitarians, from whom 
we were led to expect so much, should pestilence invade us, 
and who had so long boasted of the resources of Sanitary 
Science and the " gigantic strides" it had made, were as 
helpless as they had always shown themselves in former 
epidemics. They were even less noisy than usual, and less 
sanguinary ; for they began no prosecutions against the ene- 
mies of the public health. Except in one instance, — in a city 
of nearly a million of inhabitants, — where a Board of Health 
made a silly order which had no other effect than to derange 
and impede transportation, they offered no suggestion that 
could have any bearing on the disease. By common con- 
sent, but without making any investigations, they proclaimed 
that it was not a filth-disease; yet there was as much or 
more evidence to show that it depended on filth and defec- 
tive drainage as there was that these caused typhoid fever. 
It prevailed extensively in filthy cities, as at New Orleans, 
and in filthy parts of clean cities. Chicago, with her 
slaughter-houses, was severely visited by the disease. It 
would have been easy enough for the reformers to have 
shown that at one time or another it prevailed near some 
pond, or stable, or slaughter-house, or in the vicinity of 

* Journal American Medical Association. 



EPIDEMICS, 363 

some well or stream that contained nitrites. It would have 
been easy to show that the customers of some particular 
milk-dealer were affected by the influenza to a greater 
extent than others ; but, on this occasion, the sanitarians 
seemed to have lost their inquisitorial character, and, except 
for some incoherent sanitary drivel as to whether it was a 
micrococcus, a diplococcus, a pneumococcus, or a ptomain 
that caused the disease, they were silent. They agreed that 
it was an infectious disease, — a germ-disease, — but they 
made no efforts to suffocate the germ with sulphuric acid, 
or to smoke it out with other fumigations ; they established 
no sanitary cordons, they invaded no private houses to 
isolate or quarantine the inhabitants,— they did not even 
recommend disinfection; but allowed the micrococcus, 
diplococcus, pneumococcus, or ptomain to travel how and 
where it pleased, destroying in our own country tens of 
thousands of lives. The people may be congratulated that 
the reformers in this instance were willing to hide their 
ignorance by slinking into privacy. In the study of epi- 
demics, ancient or modern, one is forced to conclude that 
the meddlesome, teasing, persecuting regulations of the 
sanitarians of every age have been utterly worthless to 
avert or control any epidemic of any infectious disease, for 
the reason that they have failed entirely to determine the 
cause of such disease ; and that epidemics are no more 
under human control than are biting frosts, scorching 
droughts, famines, cyclones, volcanoes, or earthquakes. 

Note. — Fifty years later, in Vermont, it needed only a little more excitement 
than was actually raised, to have caused similar scenes. An epidemic of diph- 
theria* broke out in a small town in that State. The children of a school had 
drunk water from a brook. The rumor was noised abroad that it had been 
poisoned by a farmer who had thrown dead animals into it. After a pretended 
investigation, the secretary of the National Board of Health writes, " The 
farmer who has caused this wholesale slaughter of children is in danger of 

* Report of the National Board of Health. 



364 VAGARIES OF SANITARY SCIENCE. 

personal violence, or even of a trial of manslaughter." The secretary con- 
tinues, " As one child after another dies in agony, becomes a repulsive, bloated 
corpse, and is hastily buried before it can fall to pieces, the wails of some of 
the mothers are heart-rending; and the feelings among the men, as the news flies 
around the neighborhood, is very dangerous for the cause of the disaster. . . . 
The indignation is spreading" into neighboring towns. The secretary writes 
that a farmer declares " there is lightning in the air." 

So far there is nothing but noise, fright, panic. If we had our reformer from 
Michigan here, whom we have quoted on page 27, we should see a vindication 
of Sanitary Science by mobbing, hanging, and burning. After a while the fury 
which the sanitarians raised and kept up quieted down, and a calm inquiry 
followed. It was found out that diphtheria was prevailing in the town four 
weeks before the school assembled ; that the disease was in adjoining towns in 
Vermont and in New Hampshire. No trace could be found of the dead 
animals with which the farmer poisoned the brook, and which formed the cause 
of the heart-rending wails of the mothers, for which he was to suffer personal 
violence or trial for manslaughter. All that could be discovered was that, a 
year before, a dead horse was buried seventy-five feet from the edge of the 
brook, and two rods above where the children drank. The report does not 
say whether the horse was buried ten feet above or ten feet below the water- 
level of the brook. The State chemist examined the water, and found that 
there was nothing in it detrimental to health ; and, finally, somebody showed 
. that the cause of diphtheria in that town was the want of ozone in the atmos- 
phere ! 



CHAPTER XVII. 

Boards of Health. 

Notwithstanding the divinity that hedges the sanitarians; 
notwithstanding their exalted character when organized as 
Boards of Health ; notwithstanding that behind the resonant 
voice of these philosophers presumably reposes a gravid and 
comprehensive intellect, unceasingly occupied in solving 
problems which have to do with saving our race from deso- 
lating epidemics, we hold it to be neither impious nor 
irreverent to lay down the proposition, — which seems unde- 
niable, — that in so far as they have directed their efforts and 



BOARDS OF HEALTH. 365 

consumed their energies on subjects which have no influence 
on individual or public health, and in so far as they have 
diverted the attention of the people thereto, just so far have 
they retarded and obstructed true progress in that branch 
of medical science which is devoted to hygiene, and just so 
far they have been a positive detriment to the public health. 
In the present chapter we purpose to review briefly some 
of their transactions, limiting our comments to the more 
important boards which have been established in this coun- 
try. The Metropolitan Board of Health was set up in New 
York City in 1866. It had jurisdiction, not only over the 
city, but over Brooklyn and some other towns. In its first 
report it proclaims its belief that filth and its concomitants 
cause the great destruction of life in New York City. The 
board opened its campaign by issuing that year thirty-one 
thousand orders against filthy alleys, privies, cesspools, 
urinals, stables, slaughter-houses, and bone-boiling estab- 
lishments. It looked sharply after the markets, and explored 
the cellars in which people lived. The board says * that 
" man's inhumanity to man" is nowhere more observable in 
the sacrifice of human life than in the disposition of pro- 
prietors to rent basements and cellars for people to live in. 
Although some of the owners " are persons of the highest 
character," they make no effort to bring about any compro- 
mise with the applicants for a shelter by offering them a 
home in their own residences, but actually rent them the 
cellars ! As an excuse for the bad condition of these, " the 
proprietors urged the filthy habits of the tenants, losing 
sight of the fact" that for the tolerance of these habits the 
owners " themselves were alone responsible." The board 
says that the only way to reform this condition is to hold 
the owner liable. He should make " weekly, or, if neces- 
sary, more frequent inspections." This would soon improve 

* Appendix, p. 9. 
31^ 



366 VAGARIES OF SANITARY SCIENCE, 

the habits of the tenants ; but the board does not say who 
would protect the owner from being ejected for his imper- 
tinence. 

The cholera appeared that year. The board claims to 
have made a discovery, which, if true, is of vast importance 
to mankind. It says the fact that cholera can be " stamped 
out" by the liberal use of disinfectants " is positively con- 
firmed and established. . . . The sulphate of iron destroys 
the germ of cholera." The expenses of the board that year 
amounted to $i7^,6'iZ-9^- 

The second report of the board claims a gain in life and 
health. By enforcing sanitary regulations, " the fatality and 
amount of diseases have decreased." The board issued this 
year fifteen thousand one hundred and eighty-six orders 
against filthy yards, alleys, privies, cesspools, bad v/ells, etc. 
It granted permits to keep cows, goats, and geese; to sell 
fruit, fish, meat, and vegetables. During the year a little 
event happened that would have disquieted a less firmly- 
rooted faith than that of the filth-origin of disease. Typhus 
fever broke out at the Reformatory for Young Girls. " There 
was no overcrowding, the water-closets and drains were in 
excellent order, and cleanliness universally prevailed." The 
board says that the fever was brought to the institution by 
some visitors ; but no typhus is reported elsewhere in the 
city, and why visitors should bring the disease into the clean 
reformatoiy instead of spreading it among the filthy wards 
of the town is a little confusing to a man unversed in Sanitary 
Science. 

The people in the tenement houses are still troublesome ; 
but they are thankful to the health-inspectors, and the owners 
are more tractable under the discipline of the board. Some 
of them — the board does not say whether they are " persons 
of the highest character" — are hiding behind " middlemen," 
to whom they lease their houses, either because the owners 
do not reHsh the persecutions of the board, or do not want 



BOARDS OF HEALTH. 367 

to undertake the education of their tenants in good manners. 
These middlemen are even worse than the owners, and we 
have a new illustration of " man's inhumanity to man," for 
in subletting they try to make all the money they can out of 
the tenants. The total disbursements of the board this year 
were;^243,395.i3. 

The next report does not felicitate the people on a gain in 
life and health, but says, '' The fact that the mortality among 
children is so great, leads the board to inquire if there is not 
something radically wrong in their management." It thinks 
that instead of removing the filth from the tenements it would 
be better to move those who live in them into the country. 
But the difficulty in the way is that they refuse to go ; they 
prefer to live where they are. They are hard to deal with ; 
they defeat the benevolent schemes of the board for their 
good. The very windows which it ordered put in, to provide 
fresh air, they have sealed up with paper, pasted across them. 
They clog the sewers with ashes and garbage. Filth abounds 
everywhere, and the only way out of the trouble is to hold 
the landlord responsible, " making him pay the penalty of 
his tenants' misdeeds." The board has crushed a good deal 
of opposition to sanitary reform ; but it encounters an unex- 
pected obstacle in the fact that some people deny that nui- 
sances and offensive trades cause disease ; and this doctrine 
" meets with countenance from persons of intelligence and, 
in many respects, of considerable knowledge in hygenic 
matters." 

This year the Texas cattle-disease gave an opportunity to 
excite a panic regarding diseased meat. As has been seen 
on page 203, it only needed a hint from the board — for no 
investigation showed that the beef was the cause of the in- 
crease in bowel disorders — to deepen and widen the panic, 
which became quite general. The board is still pursuing 
the owners of stables and slaughter-houses, and the melters 
of fat. It says that the filth only requires " heat and moist- 



368 VAGARIES OF SANITARY SCIENCE, 

ure to convert it into poisonous gases, which are now knowrt 
to be the efficient agents in producing the severest forms of 
diarrhceal diseases in cities." The wharves are in a condition 
perilous to health. They cover immense beds of putrescent 
filth, which is stirred up by every tide. Powerful disinfect- 
ants are poured into the gutters, and later in the summer — 
for the temperature has now fallen — the deaths " from that 
class of diseases produced by putrescent organic matter" 
begin to decline. 

The death-rate this year was 25.45 P^^ lOOO, and the per- 
centage of zymotic to total mortality was 29.8 1 . In New York 
and Brooklyn there were two hundred and sixty-eight deaths 
from diphtheria this year. The registrar takes comfort that 
the death-rate in later periods of life seems to be declining, 
and he ascribes this to the spread of sanitary knowledge. 
The expenses this year were ;^ 164,40 1.89. 

The next report says that the mortality of the previous 
year was less than that of any for the last four years, except 
1867, and that the benefits of sanitary improvements "are 
amply illustrated." Besides vigilantly looking after the privies 
and garbage, the board has extended its warfare : it has 
reached out for the breweries and distilleries and gas-works, 
and has begun to pay attention to kerosene oil and smoky 
chimneys. Milk and water are analyzed ; and cosmetics 
are chemically examined, among others, " Hagan's Mag- 
nolia Balm," " Eugenie's Favorite," and the ** Superior Lily 
White." With few exceptions, all of the articles for the 
improvement of personal beauty and the concealment of 
personal defects " are highly dangerous to the health." The 
only things which the board has inquired into and found 
" dangerous to the health," are the cosmetics ; but, strange to 
relate, it takes no measures to suppress their manufacture or 
sale. It continues, however, to fight the slaughter-houses 
and other establishments, which have never been proved to 
have caused sickness ; indeed, they have not been investigated. 



BOARDS OF HEALTH. 369 

The death-rate this year was 25.13 per 1000, against 25.45 
the year before, estimating the population at one million. 
Sanitary improvements are '* amply illustrated" by the rise in 
the percentage of zymotic in proportion to total mortality, it 
being this year 30.50 against 29.96 per cent, of the previous 
year. The board says, " What the death-rate might have 
been without the intervention of the Board of Health it 
is impossible to compute." 

In 1870 a new board was formed for New York City alone. 
In its first report we find that the death-rate of the city has 
risen to 28.79 per 1000 of the population, and the percentage 
of zymotic to total mortality to 30.60. Nothing is said now 
about sanitary improvements being " amply illustrated," but 
the increase in mortality is laid to the heat. The mean tem- 
perature of the five summer quarters ending 1870, was 74°, 
70°, 75°, 72°, 74°, omitting fractions. A rise of two or three 
degrees in the thermometer amply illustrates the futility of 
sanitary improvements. 

The board is in despair about the tenement-house people, 
who continue to give a great deal of trouble. They are 
poor, and filthy, and ignorant ; they pay no attention to the 
instructions of the board ; they allow their children to run 
at large, and to be out late at nights ; and when they are sick 
they are not properly cared for. The pesky landlords show 
no disposition to go among the tenants to educate them, but 
seem rather to avoid them, by still renting the property to 
the " middlemen," who are reckless and grasping. This year 
two thousand five hundred and seventy-six prosecutions have 
been commenced against the enemies of the public health. 

. The board granted permission to keep cows, geese, goats, 
and swine; to sell poultry, vegetables, pork, fish, and beef; 
to blast rocks, to cart bones, to salt hides, etc., although 
what special diseases were caused by these occupations, or 
prevented by the permits, is not mentioned. 

The percentage of zymotic to total mortality for the last four 
y 



370 VAGARIES OF SANITARY SCIENCE. 

years has been 28.41, 29.96, 30.50, 30.60; and, in spite of all 
the permits, regulations, and prosecutions, the mortality 
from typhoid fever is *' somewhat excessive," being nearly 
double what it was the year before. The expenses of the 
board this year were ;^ 169,478.27. 

During the summer yellow fever broke out at Governor's 
Island ; its cause is related on a previous page (page 286). 
There were eleven cases in New York City, nine of which 
proved fatal. Although some of these cases occurred before 
the board had any knowledge of the fever, and, as Dr. Nott, 
who reported on the disease to the board, says, though all 
" were quartered in crowded and filthy parts of the city," 
they did not communicate it to others. The board moved 
with energy on Governor's Island — seeming ambitious to 
pass into history, along with General Butler, for having 
** stamped out" yellow fever. It made a great alarm through- 
out the country about the disease, advising the evacuation 
of the island, the burning of certain buildings thereon, and 
other radical measures. Here we record the only instance 
in the history of sanitary reform in which common sense 
sustained itself against sanitary terror. If the police emis- 
saries of the sanitary Robespierres could only have reached 
General McDowell, who was in command, the matter would 
probably have had a different ending, for surely sans culotte 
never felt keener triumph in gazing on the headless trunk 
of an aristocrat than did the sanitary terrorists in proclaiming 
as a foe to the public health a wealthy and influential citizen. 
But the general, calmly intrenched on Governor's Island, 
faced the terrorists with composure. He wrote to them that 
he had quarantined the island, at great inconvenience to the 
service, and that the only infraction of the quarantine had 
been made by the board themselves, who had persisted in 
visiting the island and then returning to New York. For 
good reasons, he refused to evacuate the place. As to 
burning the buildings, which the board recommended, while 



BOARDS OF HEALTH. 37 1 

he did not deny that a conflagration of that kind was a good 
disinfectant and well adapted to a barbarous people, he had 
heard that there were other methods. He reminded them 
that the people in New Orleans and Mobile, after they had 
suffered from yellow fever, did not burn down the towns. 
In conclusion, he positively declined to comply with the 
recommendations of the board. It was now October. On 
the loth of this month a frost came. The fever was ended, 
and the opportunity to " stamp out" the disease was gone. 

The next year, although a great improvement in general 
cleanliness is announced, the report gives the death-rate as 
28.6 per thousand, and the percentage of zymotic to total 
mortality has mounted to 31.01. The board is still pursuing 
the slaughter-houses, fat-rendering establishments, and 
stables, though no epidemic, and not even a single case of 
disease, is yet assigned to them. Keepers of stables are 
arrested, but the grand jury refuses to indict them, although 
the board regards their business as " so notoriously injurious 
to health." This year three thousand and sixty prosecutions 
were begun against the foes of the public health. The 
expenses were ;^ 194,976.54. 

The tenement-house class is still averse to leaving the 
filthy, crowded parts of the city. It is pleasanter for them 
to live there, the board says, than in airy and remote spots, 
away from the society of their friends and companions. 
Besides, the land-owners in the upper part of the city are 
not much better than the owners of the houses down-town ; 
for the board says they are holding the land at a high price, 
and if the tenants were moved there, they could not afford 
to remain ; and, altogether, there is a prospect that the sel- 
fishness of mankind will be a permanent check to sanitary 
reform. There was some fright this year about the cholera, 
which broke out in the little country-town of Woodridge, 
New Jersey. Consequently, extra precautions were taken, 
and cleanliness was enforced everywhere. 



372 VAGARIES OF SANITARY SCIENCE. 

The fright was hardly past, when cerebro-spinal menin- 
gitis appeared in New York. The physician who reports 
on this outbreak says it is caused by ** the excessive quanti- 
ties of filth which had accumulated throughout the city." 
This is a little startling, because in a previous part of the 
same report it is clearly intimated that the removal of this 
filth was what saved the city from cholera that year. We 
are now told that the spaces under stores and dwellings are 
" surcharged with an enormous quantity of sewer-gas," and 
the condition of local drainage is such as " would neces- 
sarily produce the disease." But the same report says that 
the meningitis first broke out in the best and cleanest parts 
of the town, and " subsequently" developed in the lower 
wards, which were overcrowded, badly ventilated, and 
exceedingly filthy. The doctor says that the professional 
mind has become convinced that in sewage " lurks a 
gaseous poison, whose direct effect on the human system is 
typhoidal." 

The third report also tells of the unrelenting war on the 
slaughter-houses, stables, and tenements. " In the interest 
of the public health" the board orders the removal of 
cushions from the horse-cars, because vermin find there a 
hiding-place. The board has also found out that there are 
a great many irregular practitioners in town, and, judging 
from the amount of business they do, it thinks the death- 
rate is increased by their incompetence. This year the 
general death-rate is 32.6 per thousand, and the percentage 
of zymotic to total mortality has risen to 36.19 ! 

The board thinks it is time that saleratus, and baking- 
powders, and cream-of-tartar were examined. It keeps its 
official eye on the water, extends its vision to the confec- 
tionery and the tobacco and cigars. But now a new Hght 
dawns upon its view. It is suspected by somebody that 
some cases of syphilis have been caused by the rite of cir- 
cumcision. There is no financial report this year. 



BOARDS OF HEALTH. 373 

The reports for 1874-75 tell us that the board is still 
fighting the slaughter-houses and stables. For the twenty- 
months ending December, 1875, it had begun five thousand 
two hundred and eighteen prosecutions of the conspirators 
against the pubHc health. A large area — nineteen square 
miles, to be exact — has now been annexed to the city. The 
general death-rate in the whole area of the city for 1874-75 
was 27.57 ^^d 29.47 per thousand. The percentage of zymotic 
to total mortahty for the two years was 34.12 and 35.52. In 
1871-72-73-74-75 there were 308, 224, 903, 1665, 2329 
deaths from diphtheria in the city. The mortality from this 
disease was increasing enormously, while the prosecutions 
against the adversaries of the public health were going on, 
and the war against filth was being vigorously waged. More- 
over, this disease, which the board said was pecuHarly a 
filth-disease, created and sustained by it, was most steadily 
and fatally prevalent in the Nineteenth, Twentieth, and 
Twenty-second Wards. The registrar says that its persist- 
ence in that open section, on the highest ground ; its preva- 
lence in the neat as well as in the worst parts of the Seventh, 
Ninth, Eleventh, and Eighteenth Wards, and its rare presence 
in the most crowded and filthy quarters, indicates that 
" diphtheria does not as uniformly elect the most unhealthy 
wards." 

The board says that there is great ignorance on the " vital 
question" of plumbing. " A siphoned trap, or the absence 
of a trap," has " undermined the health of adults and slain 
the little ones." Consequently, the most useful work of the 
bureau is now to look after the plumbing, and a plumbing- 
ordinance is called for. Defective joints have been found. 
A light was applied to one of these, and the sewer-gas was 
" of such a foul and poisonous nature as to extinguish the 
light and ignite the escaping gas, which burned with a blue 
flame." The sewer-gas is forced past the traps. Now tlie 
mystery increases, for in some cases there are defects found 

32 



374 VAGARIES OF SANITARY SCIENCE. 

" caused by too much trapping." Some new creation is 
necessary to account for the rise in general mortality and in 
that from zymotic disease, and the sewer-gas comes in at 
just the right moment. The diphtheria having been caused, 
as the board said, by the bad plumbing, plumbing-laws were 
passed ; but the more stringent they were made, the higher 
went the mortality from this disease. For the ten years 
ending 1885 the proportion of zymotic to total mortality 
reached nearly thirty-two per cent. In 1881 it touched the 
enormous figure of 34.93 per cent., — a point much higher 
than it averaged before the board made any efforts to eradi- 
cate the causes of zymotic disease. 

Let us now survey the result of the board's work for the 
first ten years of its existence. From the beginning its aim 
and purpose had been to reduce the amount of zymotic dis- 
ease, which was regarded as preventable by all eminent 
sanitarians. The board having announced that it knew the 
causes of such disease, and only needed power and money 
to exterminate it, received unlimited power, and expended so 
much money that it apparently did not dare mention the 
amount for 1 873-74-75 . It made tens of thousands of prose- 
cutions, and furnished plenty of ofifices to its friends, and the 
friends of its friends. Nevertheless, we find that the general 
death-rate was steadily increasing, and the percentage of 
zymotic to total mortality for the ten years ending 1875 was 
32, 28, 29, 30, 30, 31, 36, 32, 34, 35, omitting fractions. In 
the mean time, the area of the city had been nearly doubled 
by the addition of the rural district of Westchester County. 

The board ceased its reports after 1875. It no longer 
sought to excuse itself by words and accuse itself with figures, 
and for many years we had to be content with the vital sta- 
tistics of the city. We may be pretty sure that there was no 
abatement of prosecutions and no decline of power, for in 
the New York Sun of June 10, 1891, we read that on the 
receipt of an anonymous communication, which stated that 



BOARDS OF HEALTH. 375 

some children had been made sick by candy bought of Mrs. 
Katherine Vath, of 168 Avenue B, a sanitary inspector went 
to the store, " destroyed a quantity of the colored candy, and 
took some to the Health Board for analysis'' (italics ours). 
" No children could be found who had become sick from 
eating the candy. It is thought that the complaint against 
Mrs. Vath's place was made by a rival." 

In September of the same year the board destroyed tons 
of grapes, on suspicion that they had been sprayed with 
" Bordeaux mixture." No case of sickness had been charged 
to the consumption of grapes which had been treated with 
this mixture, although the crops of three previous years had 
been subjected to it. After the condemnation of the fruit 
the board proceeded, as it did after the destruction of Mrs. 
Vath's goods, to investigate, for the purpose of ascertaining 
if the grapes contained anything poisonous, or if the Bor- 
deaux mixture itself was harmful. Chemical analysis sus- 
tained the experience which the people already had who had 
eaten the crops of the previous years. The grapes contained 
no poisonous substance. A great panic, however, had been 
raised, which came near causing a total loss of the entire 
harvest to the growers, and depriving the people of a deli- 
cious and healthful fruit. Sanitary Science, however, had 
made a " gigantic stride." How far this panic might have 
been carried we have no means of knowing. The Board of 
Health soon found out that this time it was not dealing with 
Mrs. Vath, but with a set of men, growers and dealers, who 
were determined to face its nonsense and violence even in 
the presence of a panic which it had raised about the public 
health. 

After 1875 there was a steady increase in the number of 
offices, for in the report for 1890 are listed the names of one 
hundred and sixty-six officials, besides a sanitary police, 
consisting of forty-two patrolmen, two roundsmen, and 
one sergeant, and a little later an appropriation of nearly 



37^ VAGARIES OF SANITARY SCIENCE. 

half a million dollars was granted for the expenses of the 
board. 

During the last six years there has been a small apparent 
decrease in the amount of zymotic mortality in New York 
City. Croup, which before figured in the zymotic class, and 
which gave an annual average of seven hundred and sixty- 
three deaths for the last ten years, is now transferred to the 
column of respiratory diseases. Puerperal fever, which before 
was in the zymotic class, and which — with puerperal diseases, 
metritis, and peritonitis — caused for the last ten years an 
average of four hundred and two deaths, appears in 1889 
under another head. Besides, the number of persons who are 
now removed to the hospitals, when they are seized with illness, 
is very much larger than formerly. There can be no doubt 
that many of these survive who would die if left in their own 
homes ; and where the disease is of an infectious character 
the danger of contagion is largely diminished. The average 
annual number of deaths in the hospitals for the ten years 
ending 1880 was 4920; the average annual number for the 
ten years ending 1890 was 7369, the number in 1890 being 
8316. By general vaccination, and by a cessation of the 
unknown epidemic influence of small-pox, the deaths from 
that disease, which averaged annually four hundred for the 
ten years ending 1880, were reduced to an average of ninety- 
six a year for the decade ending 1890. 

The board will hardly claim that the apparent reduction 
of zymotic disorders by changing the nomenclature of dis- 
eases, and the real reduction by the voluntary entrance of 
sick people to the hospitals, by vaccination and the sub- 
sidence of epidemic influence, were due to the passage of 
plumbing-laws, to the prosecution of the foes of the pubhc 
health, to the deluging of the gutters with disinfectants, or 
to the swearing-in of a squad of sanitary police. 

Another way to estimate the work of the New York Board 
is by considering the rate of infant mortality. This, accord- 



BOARDS OF HEALTH. 377 

ing to the sanitarians, is a finer test of the efficacy of so-called 
sanitary measures than the proportion of zymotic to total 
mortality. The total number of deaths in New York, for 
the ten years ending 1880, was 290,785; the total number 
of deaths under five years was 138,499, the percentage of 
infant mortality being 47.6. For the next ten years, ending 
1890, the total number of deaths was 377,516 ; the number 
under five years was 163,364 ; the percentage of infant mor- 
tality for the latter period was 43.27. We should bear in 
mind that now a great many children who are taken with 
infectious diseases are received into hospitals designed espe- 
cially for such cases. If, in addition, we consider the efforts 
of private benevolence, — the St. John's Guild, the King's 
Daughters, the Hebrew Sanitarium, the Tribune's and the 
World's Fresh-Air Funds, all of which must have a marked 
effect on infant mortality, — there is a beggarly residue for the 
New York Board of Health to claim, as a result of all the 
power which has been conferred upon it, and the money 
which has been lavished for its pretended sanitary improve- 
ments. Notwithstanding, the board could say, as it did in 
1869, "What the death-rate might have been without the 
intervention of the Board of Health it is impossible to com- 
pute !" 

There is another element in this calculation which it is not 
unimportant to consider, — namely, immigration. During the 
last ten years more than 300,000 people have come from 
Italy. The proportion of sexes in this number has been 
about eighty per cent, males and twenty per cent, females. 
The immigrants from Hungary have amounted to about 
128,000, seventy-four per cent, being males and twenty-six 
per cent, being females. Previous to 1880 the immigration 
was almost wholly from Ireland, England, and Germany. 
The proportion of the two sexes from Ireland was about 
equal. That from Germany was about fifty-seven per cent. 

males and forty-three per cent, females. Of the 555,496 

32* 



3/8 VAGARIES OF SANITARY SCIENCE. 

arrivals in 1891, 135,766 were registered as destined for the 
State of New York. This disproportion of sexes would not 
only affect the present birth-rate, compared with that previous 
to 1880, but also the death-rate of New York City. 

For eight years ending 1882 the percentage of infant to 
total mortality was 46.63 ; for eight years ending 1890 it was 
42.55, — a sharp decline beginning in 1883, when the immi- 
gration began to be plentiful from Italy and Hungary, being 
in the latter year 40.74, against 46.20 in 1882. 

It is just at this period, too, that the decline commences 
in the proportion of zymotic to total mortality ; and that 
occurs largely from diarrhoeal diseases under five years, the 
number of such diseases being 3398 in 1883, and 4050 in 
1882. For eight years ending 1882 there were 29,244 diar- 
rhoeal deaths under five years, while with a steadily-increasing 
population there are for the next eight years 28,242 deaths. 

It is highly probable that, all over the country, there has 
been a decline in mortality from zymotic disease. This may 
be due to those unknown causes which, in by-gone ages, 
brought about the disappearance of certain epidemic diseases 
then prevailing ; or it may be due to more intelligent sepa- 
ration of the sick from the well, and to improved methods 
of treating contagious diseases. 

This diminution of zymotic disease, by other than sanitary 
measures, is illustrated by New Haven (page 92), a city of 
100,000 inhabitants. 

It is a noticeable fact that, in estimating the decline in the 
general death-rate, — which, after all, is not so great as was 
taking place before the rise of Sanitary Science, — and also 
the slight decrease of infant mortality, and of that from 
zymotic disease, the sanitarians wholly ignore the improve- 
ments which have been made in the methods of treatment 
The medical profession, as a rule, is not given to much 
boasting about its own progress and achievements ; neither is 
it over-sensitive to the praise of the public. Nevertheless, it is 



BOARDS OF HEALTH. 379 

not content to rest quietly under the humiliating imputation 
that it has done nothing for mankind ; and it is bold enough 
to assert that the general increase in longevity is due, in no 
small measure, to the introduction of new remedies and the 
more intelligent use of old ones. If we take into consider- 
ation all of these facts, there is absolutely nothing in the 
small gain to life and health which can be fairly claimed for 
the reformers. 

In New York City, for instance, we have the spectacle of 
a Board of Health, clothed with despotic power, furnished 
with an enormous sum of money, supported by a battahon 
of officials, with a sanitary code of between two and three 
hundred sections. This board has its pathologists looking 
out for the microbes ; its chemists seeking for the ptomaines, 
and searching the air, water, soil, ice, milk, meat, cosmetics, 
and saleratus for impurities ; its meteorologist watching the 
weather; its inspectors of fish, flesh, poultry, vegetables; 
its inspectors of tea and coffee ; plumbing-inspectors and 
general sanitary inspectors ; disinfectors ; inspectors of virus 
and vaccination ; its inspectors of contagious diseases, with 
strict laws to compel the report of every case. Yet this 
city, possessing superior natural advantages for salubrity, 
and so protected by all the paraphernalia of Sanitary 
Science, not only shows no real decline in mortality on 
account of sanitary laws, but the highest death-rate of 
any city in the United States ; that is to say, an average of 
26.50 per thousand of its population for the last ten years. 

Brooklyn and Boston, which come next to New York in 
sanitary regulations and sanitary prosecutions, show a death- 
rate of twenty-three and twenty-four per thousand. Phila- 
delphia, which is comparatively poorly supplied with sanitary 
officials and sanitary laws, shows an average death-rate for 
ten years of twenty-one per thousand. In the Philadelphia 
Board of Health Report for 1889 we are told that " there is 
no systematic inspection of food" in that city ; the milk 



380 VAGARIES OF SANITARY SCIENCE. 

inspection is a failure, and there are thirty-seven cemeteries 
wherein were placed nearly five thousand bodies in 1889; 
" vast multitudes of human remains lie crowded within these 
contracted places." Mr. George E. Waring, in a lecture * 
on the drainage question of Philadelphia, says that nearly 
all the sewers here, except the large main ones, are built as 
they were forty years ago ; the lower half is laid without 
mortar, and the soil takes up the liquid sewage ; the means 
for conducting house-drains is a sort of " go-as-you-please." 
The inlet basins of the sewers are clogged with filth " to 
putrefy before the eyes and under the noses of the people." 
This is shovelled into the street, and there left to drain until 
carried away by the contractor, or scattered by the wheels 
of passing carriages. The sewers are practically without 
any ventilation, and accumulation of gas is unavoidable. 
"If a judicious and proper connection of plumbing-work, 
with even tolerable sewers, exists anywhere within the city, it 
is the exception and not the rule," and probably not one 
soil-pipe in a hundred in Philadelphia has a good ventilation. 
Some of the houses are built over old cesspools which still 
receive the drainage of the new house, and the method of 
getting rid of the filth is through cesspools and privies. 

Losing sight for a moment of the inflexible law in Sanitary 
Science that two and two make five, in order to ascertain 
how the inhabitants of Philadelphia are affected by her 
sanitary condition, we naturally turn to the vital statistics 
and compare them with those of New York, where, through 
sanitary law, there is protection against all of these multi- 
plied causes of disease. Besides noting the general death- 
rate, which averages 21 per thousand against 26.50 for New 
York, we apply those other two unerring touchstones to 
prove the truths of Sanitary Science, — namely, proportion 
of zymotic deaths and infantile deaths to the total mortality. 



[885. 



BOARDS OF HEALTH. 38 1 

In Philadelphia the percentage of zymotic to total mortality 
has averaged about 17 for the last ten years. It was 23 in 
1 88 1, when about 1400 people died of small-pox, and has 
been steadily declining since that year, reaching some years 
as low as 15 per cent., against 25 to 32 per cent, for New 
York. The percentage of infant to total mortality in 1890 
was 37. Philadelphia expended for health purposes in 1889 
less than one hundred thousand dollars. Chicago, which 
ranks with Philadelphia as regards sanitary law, has had an 
average death-rate for the last ten years of twenty per thou- 
sand ; while New Haven, bereft of all sanitary measures, 
shows a death-rate of seventeen per thousand, and a more 
constant fall in zymotic mortality than any of the other 
cities. 

It may be said that it is not proper to compare a city of 
100,000 with one of 1,600,000 people. But this is what the 
sanitarians, over and over again, have invited us to do. 
Herein, they said, was the test of Sanitary Science ; and they 
have repeatedly declared that a large, and even a crowded 
city, controlled by proper sanitary laws, is, and necessarily 
must be, healthier than a small one, or even a country vil- 
lage, which has no sanitary supervision. 

We respectfully submit to scientific men, whose subsist- 
ence does not depend on the propagation of error, and 
whose reputation does not depend on the periodical excita- 
tion of a panic, whether, in view of these figures, it is not 
time to seek elsewhere for the causes of epidemic and infec- 
tious disease than in a siphoned trap, a disreputable privy, 
the casting of slops on an ash-heap, nitrites in water, or a 
bad smell from a slaughter-house. 

In 1892 the approach of cholera was the signal for great 
sanitary activity by the New York Board. They said they 
were prepared to " stamp it out" if it arrived. Remembering 
that for twenty-five years numbers of epidemics had raged 
in New York without being modified in the least by the acts 



382 VAGARIES OF SANITARY SCIENCE. 

of the board ; remembering, too, that distinguished medical 
men who had made a profound study of and had had a wide 
experience with cholera declared that its causes and preven- 
tion were unknown, and that neither quarantine, nor isola- 
tion, nor disinfection, even when carried out with military 
severity, had any effect to stay its progress, we confess our 
scepticism of the board's ability to restrain it ; but the con- 
fident speech, and the jaunty air with which they delivered 
it, were calculated to inspire the people with the belief that 
the members of this board actually possessed some secret 
remedy or some sanitary prescience whereby they could halt 
and "stamp out" cholera. The first sanitary measure which 
the board took was to arrest and bring to judgment a number 
of milk-dealers who had been accused of selling watered 
milk ; afterwards some spiteful man or woman complained 
of some respectable hotel- keepers for serving this milk, and 
these were arrested. The wretched occupants of some 
houses — said to be unsanitary — were turned into the street, 
with no shelter at all, or were forced to find lodgings which 
were perhaps more miserable than those from which they 
had been ejected. A good many men and women, penny 
peddlers of fruit, — fifty-six in one day, — were arrested on 
the charge that their fruit was either too ripe or not ripe 
enough. At the refuse-market, on Ninth Avenue, a small 
boy who had some stale muskmelons was sternly repri- 
manded by the medical gentleman who was acting as an 
escort to the board's garbage-cart. The young malefactor 
blubbered, and probably lied when he said he did not know 
the stock was bad. He was told that if he w^as bigger he 
would be arrested ; though why a diminutive enemy of the 
public health should escape the vengeance of sanitary law 
was not explained. Another man was arrested for killing 
chickens. Nearly a hundred arrests of different people 
occurred in the course of three or four days. These sanitary 
measures called forth the applause of the people. Vessels, 



BOARDS OF HEALTH. 383 

crowded with passengers, with clean bills of health, and 
which had cleared from perfectly healthy ports, were held at 
anchor in the lower bay. For many long days infected 
ships, loaded with anxious men and women, were detained, 
the well shut up with the sick. In some instances these 
passengers were drinking and using for toilet purposes 
water from the Elbe, which at that time was said to be 
causing hundreds of deaths daily in Hamburg. Had the 
cholera arrived at New York with the suddenness with 
which it reached Hamburg, these crowded ships, motionless 
on a motionless sea, the passengers oppressed with fear, 
forced to breathe a stagnant air, and deprived of exercise, 
would have offered the most favorable nuclei for the out- 
break of cholera. It was not the fault of the health authori- 
ties that they were not decimated by pestilence, but because 
the conditions — the unknown conditions — for an epidemic 
were absent in New York in 1892. 

When deaths occurred on the infected ships the corpses 
were cremated. It is practically of no importance whether 
the dead human body is thrown into the sea, tossed to wild 
beasts, incinerated in an oven, or put to moulder in the 
earth, the final result, a return to its original elements, is 
attained. There happens to be, however, a very tender and 
precious sentiment in the minds of some hundreds of mil- 
lions of civilized people in favor of what is called Christian 
burial, and to go out of the way to treat this sentiment with 
disrespect is brutal. The burning of these bodies was 
something very impressive to the vulgar mind; it gave 
occasion for startling paragraphs in the papers ; it intensified 
the fears of friends who were almost in sight of the crema- 
tory, and whose bodies were perhaps to be similarly treated. 
The testimony of physicians in 1832, in 1849, ^"^ 1S52, and 
of the French commission in 1866, quoted on a previous 
page, would appear to determine the harmlessness of a body 
dead of cholera. At a sitting of the Academy of Medi- 



384 



VAGARIES OF SANITARY SCIENCE. 



cine,* Paris, October 7, 1884, M. Ricord testified that during 
the progress of cholera in 1832 he continued his lessons in 
operative medicine to numerous pupils, many of whom were 
from abroad. He used bodies dead of various diseases, 
" notamment des cadavres de choleriques,'' and none of the 
assistants or spectators of these operations were seized with 
cholera. In i854,t Mr. Radcliffe writes to the Board of 
Health of London that bodies dead of cholera do not re- 
ceive the same funeral rites that other bodies do on account 
of fear of contagion from them, and he inquires if this fear 
is well founded. The board reply that while they recom- 
mend the speedy removal of corpses from dwellings, they 
do not consider such precautions as Mr. Radcliffe alludes to 
as necessary for the public health. At a sitting of the 
Paris Academy of Sciences, J January 7, 1867, M. Dumas 
stated that of eleven hundred persons engaged in burying 
the dead during the cholera epidemic in Paris, only one was 
stricken with the disease. He says disinfectants were used, 
but we now know that the disinfection practised in 1865 
was inefficient and unreliable. We can find nothing re- 
corded on this subject during the epidemic of 1884-85, ex- 
cept the official report of the statistics of cholera at Mar- 
seilles, which informs us that '^ the men who were employed 
to bury the dead, to disinfect the houses, and to clean the 
sewers enjoyed remarkable immunity." Would the physi- 
cians who ordered the cremation of these bodies in New 
York have hesitated to perform autopsies on them ? Would 
they not have invited their friends and relatives, supposing 
them to be proper persons, to assist at and observe these 
ceremonies, and would they not have assured them that 
there was no danger from these bodies ? 

The authorities in New York behaved as if they thought 

* Bulletin de 1' Academic de Medecine, 1884. 

f London Lancet, vol. ii. % Cotnptes-Rendus, 1867. 



BOARDS OF HEALTH, 385 

the public health would be protected in exact ratio to the 
annoyance, distress, and expense which they caused to indi- 
viduals. It must be admitted that these " sanitary measures" 
had the sanction of five hundred years of trial. They were 
precisely those of the fourteenth and subsequent centuries. 
In all candor we submit the question to intelligent medical 
men if they were not either puerile or mischievous ? The 
authorities at Hamburg had been blamed for a want of 
sanitary vigor, and Dr. Krause, the health-officer, by a kind 
of childish vengeance, was driven from office. Does any 
physician, or even any intelligent layman who has given the 
subject any reflection, believe that if, in Hamburg, all of 
the milk-dealers had been jailed, the hotel-keepers dis- 
graced, the penny fruit-pedlers arrested, the small boys 
brow-beaten, destitute people thrust into the street, crowded 
vessels detained, or a crematory erected, that city would 
have been saved from the scourge of cholera ? It should 
not be forgotten that men who possess the soundest intel- 
lects in the medical profession, and who have had twenty 
and thirty years of experience with cholera, declare that 
quarantine is useless to prevent it. But supposing that it 
be effectual. It was only a pretence in New York harbor 
in 1892. There were many fissures through which cholera 
could have crept in. The pilot of one of the worst-infected 
ships, who had been on board for twenty-four hours, went 
from the vessel straight to his home without disinfection. 
He was requested not to talk about it. Favored passengers 
managed to escape, with their baggage, from these ships in 
violation of law. Dr. Sanborn, the papers said, had orders 
to shoot any person who should attempt to board the ship 
on which he was placed. But a party — the names of eight 
were given — of medical men and others visited the infected 
ships and the sick on Hoffman and Swinburn Islands and 
came back to the city. There is no account that any pre- 
caution was taken with this party. The very persons who 



386 VAGARIES OF SANITARY SCIENCE, 

clamored loudest for strict quarantine were those who broke 
it. The fumigation of passengers and their baggage was a 
subject of ridicule.* The reason why New York did not 
have epidemic cholera in 1892 was not because of sanitary- 
measures or quarantine, but because the cholera, which travels 
from place to place, did not arrive there in an epidemic form. 
When it did appear no one was more surprised than the 
health authorities themselves. There were cases enough, so 
that nine died between the 6th and 29th of September, all 
rather widely apart from each other except two. None of 
these had any connection with any case from abroad, " al- 
though untiring efforts have been made to obtain as com- 
plete a history as was possible in each case." f 

The submission to the prevailing theory of cholera is so 
complete that no one is found intrepid enough to whisper 
the heresy that it may be caused otherwise than by the in- 
gestion of the comma bacillus. No one, however, has vol- 
unteered to inform us how or when this bacillus arrived in 
New York City, or by whom the unwelcome guest was in- 
troduced, so that nine persons died of cholera, none of 
whom had had any communication with each other, with 
one exception, or had come in contact with any person or 
thing, so far as can be known, that was tainted with the 
cholera germ. So far as we can learn, there was no disin- 
fection of bodies, clothes, or houses of any of these cases 
of cholera. Indeed, no one was presumptuous enough to 
call the disease by that name until permission was accorded 
by the bacteriologists. The medical practitioner seemed a 
most insignificant person, and, as the new order of things 
becomes established, it looks as though we may dispense 
with his services altogether. No one has told us how it 
happened that the cholera bacilli, which were generated in 



* See note at end of chapter. 

f Dr. Nagle, Sanitarian, November, 1892. 



BOARDS OF HEALTH, 387 

the bodies of these nine persons, lost their potency to 
spread the disease among those who surrounded and minis- 
tered to them when they were sick, and who buried them 
after they died, although no precaution was taken. 

Notwithstanding our eagerness to proclaim allegiance to 
the prevailing theory, lest we be reproached for tardiness in 
not accepting it, as it becomes more complicated and para- 
doxical, there is danger, unless we adopt strong repressive 
measures, that before long common sense will lift its impu- 
dent head and begin to ask impertinent questions. 

That this country is in grave danger from cholera cannot 
be overlooked. Whether it can or cannot be prevented by 
human efforts, would that the functions of administration 
might be in the hands of men who, if they are needy in 
purse, would scorn to replenish it by playing on the fears 
of their fellow-citizens, who feel secure enough in their 
reputation not to desire to build one up by inventing some 
clap-trap operations to dazzle the public, and who are inde- 
pendent enough to fold their hands and do nothing rather 
than engage in annoying their humble fellow-citizens — 
penny-pedlers of fruit, rag-pickers, and bone-collectors — 
by causing their wholesale arrest for pretended offences 
against the public health. 

The Massachusetts Board of Health was established in 
1869. In the organic act creating it, its duties were speci- 
fied as follows : To make investigations into the causes of 
disease, and especially of epidemics ; to ascertain sources 
of mortality, and the effects of localities and occupations 
on the health of the people, etc. The board began its 
work with great enthusiasm. It promised, in the first re- 
port, to scale the bounds of the law which formed it, for it 
says it " will adopt the maxim, Pagan though it be, that 
nothing which pertains to humanity, in its widest sense, 
will this board deem foreign to its aims." It opened hos- 
tilities, without delay, on the slaughter-houses at Brighton, 



388 VAGARIES OF SANITARY SCIENCE. 

as is seen on page 79. There is not a particle of evidence 
offered to show that these ever caused an epidemic, or even 
a single case of disease, but for ten long years the board 
waged an unrelenting war against them and against various 
offensive trades. 

The author has searched in vain for evidence to show that 
slaughter-houses or their surroundings have any influence 
in causing disease. In the seventh report of the Michigan 
Board of Health, Dr. Hitchcock reports on slaughter-houses 
in that State. Circulars were sent to forty health-officers, 
inquiring for information respecting the condition of these 
places, and whether they had ever caused a case of sickness. 
With some few exceptions the drainage was reported as 
" none." The liquid filth was poured upon the ground under, 
or immediately around, the building, to saturate the ground 
and gradually to contaminate the wells ^^from which in most 
instances the water supplied for the premises was drawn!' It 
seems a strange omission, but there is no record in Dr. 
Hitchcock's report that a single health-officer answered the 
only question which was of importance to the public health, 
namely, whether any disease could be fairly ascribed to these 
establishments. Not a single case or suspicion of a case 
of disease is mentioned in this report as being caused by 
slaughter-houses. 

Dr. Johnson, * in a discussion on slaughter-houses, said 
that in Chicago " it is possible to bring thousands of persons 
to testify that these places are the most salubrious in the 
city." 

During the last thirty years the author has known and 
treated many persons who have been employed in slaughter- 
houses, and many families that have lived near them. Though 
they have been repeatedly and justly complained of as great 
nuisances, yet he does not remember ever to have seen a 

* Proceedings American Public Health Association, vol. iv. 



BOARDS OF HEALTH. 389 

case of sickness that was caused by them, or any disease in 
which the symptoms were in any way aggravated by prox- 
imity to these houses. 

The second report of the Massachusetts Board deals with 
a variety of topics, such as poisoning by lead-pipe, trichinae, 
homes for the poor, and employment of minors in the fac- 
tories. In the third report are essays on arsenic in paints 
and in wall-papers, on the obstruction of mill-dams, on the 
use of intoxicating drinks, and on adulterations of food. 
We are told that the analyses have actually detected minute 
quantities of sulphuric acid in vinegar ; and the report reveals 
the fact — which had been known for fifty years to every 
thrifty housewife — that burnt grain and beans and peas are 
mixed with ground coffee. 

The board does not cease its hostilities against the 
slaughter-houses and bone-boiling establishments. In 1871 
it secured the passage of a law giving it power to close at 
discretion all establishments of this kind in any town in 
Massachusetts of more than four thousand inhabitants. Why 
the towns of more than that number were thus favored 
is not explained ; but the reason why these trades are likely 
to imperil the public health in towns of four thousand 
one hundred, and be harmless in those of three thousand 
nine hundred people, is, doubtless, one of the many secrets 
of Sanitary Science. The butchers resented the interfer- 
ence and were arraigned before the courts. They might 
have won but for a circumstance which turned out very 
advantageously for the board. A butcher died from blood- 
poisoning in consequence of a wound received while dressing 
an ox which was reported to have died of disease. It was 
said, too, that one-half of its carcass had been sent to the 
Boston market. Though a death from blood-poisoning 
might have happened from a wound received in a counting- 
house, or a cotton-factory, or an iron-foundry, the accident 
was so exploited that ** wholesale alarm" was caused in Bos- 



390 VAGARIES OF SANITARY SCIENCE. 

ton. People were said to be in danger of being poisoned by 
meat. It was declared that the city had no guarantee against 
diseased meat, and evidence was brought to show that such 
had been sold and eaten; but no proof was given that any 
disease had been caused by its consumption. This occur- 
rence helped to gain a victory over the butchers, and hushed, 
for a time, the enemies of the public health ; but they soon 
began to conspire against it, and contested every inch of 
ground. It must be kept in mind that no investigation had 
been made by the board to ascertain whether these offensive 
trades affected the public health. No charge was brought 
that they had ever caused a single case of disease in Massa- 
chusetts. This report discusses the causes of alopecia areata 
and pityriasis, though it is not stated how these diseases of 
the scalp could affect the public health. 

The fourth report deals with beer-shops and prohibition 
laws, food-flavors, etc. The beer-shops are proved to be a 
nuisance, and prejudicial to the public health ; but the board 
makes no effort to get a law passed which will allow it to 
close them at discretion, as it did the slaughter-houses. It 
does not even advise the suppression of the tippling-shops. 
In an article upon the food of the people of Massachusetts, 
the writer discusses the nutritive value of fried meat and 
baked beans. The latter are recommended as a diet, if well 
done. Our author says he has found out that the average 
time spent at meals in Massachusetts is from twelve to fifteen 
minutes. He protests against this custom ; but neither he 
nor the board tells us how State medicine can suppress it. 
Rapid eating is certainly an injury to the public health, and, 
besides, it detracts from the dignity of the Massachusetts 
citizen ; but it is so wide-spread that the entire able-bodied 
male population in the State could not furnish a sufficient 
number of detectives and inspectors to control it. Separate 
tribunals would have to be created to reach the offenders ; 
indeed, the very inspectors and judges themselves might 



BOARDS OF HEALTH. 39 1 

need watching. Besides, the Massachusetts Board, like the 
New York Board in relation to the cosmetics, is so busy with 
offensive trades and things which do not affect the public 
health, that it really has no time to devote to the suppression 
of rapid eating. 

In the fifth and sixth reports the board tells of its wars 
against the slaughter-houses. In 1875 it proclaims that it 
has beaten the butchers at every turn. Decision after de- 
cision of the courts had gone against them ; and this year 
the joyful announcement is made that the Brighton abattoir 
has taken the place of the filthy slaughter-houses in that 
town, which have for so many years imperilled the public 
health. The battle has been long and fierce, but Sanitary 
Science has finally prevailed. But right in the midst of the 
anthems over this conquest of State medicine comes the 
news that typhoid fever has broken out at Brighton ! 
Brighton, which for so many years has been comparatively 
free from this disease ! One physician has thirty-seven 
cases, another reports fourteen. We must search for the 
cause. It is not in the filthy slaughter-houses, for they have 
given place to the cleanly abattoir. It is not in the slaughter- 
house hog, which was wont to have the laurel-like wreath 
of entrails about his burly neck, as we have seen on page 80, 
and his body smeared with blood ; there is entire reformation 
in his habits. The board says that if we must eat him, he 
looks more appetizing than he did. 

We must go deeper for the cause. We must focus the 
rays of Sanitary Science, to ascertain why typhoid fever 
breaks out at Brighton, as we did to learn the immunity of 
Hyeres from cholera. When we do so we find the cause to 
be — a faulty construction of the privies ! We are at a loss 
to know whether this condition has been of long duration, 
and has suddenly become active to awaken the disease ; or 
whether the privies of Brighton have been lately reproduced, 
and, in their reiiaissance^ have suffered from some serious 



392 VAGARIES OF SANITARY SCIENCE. 

miscalculation of the architect. There seems to be a com- 
bination of causes to produce the Brighton epidemic, for a 
more thorough investigation has discovered some ash-heaps 
on which people have thrown slops ! 

As the years go on, the board considers the pollution of 
streams, and looks after the quality of the saleratus and the 
pepper. It enters into a costly and tedious investigation of 
oleomargarine. The parturient mountain labors with energy 
and the mouse is brought forth. The board shows, through 
this expensive inquiry, by a scientific process, what had 
been known to the frugal cooks of a half-dozen civilized 
countries for a score of years, namely, that oleomargarine is 
not an unhealthy article of diet. The board keeps promi- 
nently in mind the filth-origin of infectious disease, though 
this theory is dreadfully shaken every time it investigates 
the cause of an epidemic. In 1881 a typhoid-fever outbreak 
happens at Nahant, which has always been noted for its 
salubrity. The sanitary expert is sent for. He finds ample 
cause for the disease in the wells, which are too near the 
privies ; but some of them had been there for a hundred years. 
The board is a little disconcerted, and, for once, comes very 
near distrusting its own expert. It says that Nahant has 
great natural advantages for health ; it is in marked contrast 
to Lynn, which adjoins it, and which abounds in filth, but 
has no typhoid. The board says, " A comparison of these 
two neighboring towns shows what has been so often 
observed before, that if typhoid fever originates in filth, the 
filth is very often so concealed that only an expert can 
recognize it." 

In 1884 the sanitary condition of Taunton is such that 
" it seems as if every condition was the most favorable to the 
causation of so great an amount of sickness as to arouse the 
population to a determined effort." The privy-vaults and 
cesspools are of the most primitive order, the deposits being 
open to sun and storm, and the ground filled with impure 



BOARDS OF HEALTH. 393 

matters. Mill River is the trunk-sewer of the city, and the 
stench is strong in crossing it. The wastes of the mills 
bring their quota to the pollution ; " but, so far as is ob- 
served, add nothing that is detrimental to health." There 
have been a few sporadic cases of typhoid fever here, but 
" no true epidemics of the disease." This is explained by 
the fact that the people spend a good deal of time in the 
open air, and that the factories are well ventilated. Taun- 
ton's death-rate is 15.04 per thousand. The report for 1891 
informs us that the board was petitioned to abate a disgrace- 
ful nuisance of many years' standing caused by the overflow 
of the filth of various cotton-, woollen-, and paper-mills and 
tanneries on meadows adjacent to the Neponset River. 
Portions of eight different towns along the river were ex- 
posed to emanations from this nuisance. It is represented 
" that the stench arising therefrom is at times most unbear- 
able, and is the cause of much sickness." Instead of prose- 
cuting the offenders without delay, the board did an unheard- 
of thing under similar circumstances. It started an inquiry. 
It investigated the condition of the river and found that it 
had not been exaggerated ; " it was pre-eminently a river 
which is polluted." Putrefaction here was at its highest 
grade. At one point the river contained two million four 
hundred and forty thousand eight hundred bacteria per cubic 
centimetre. The board then addressed a circular to the 
physicians who practised in the towns which were offended 
by this nuisance, asking if it " has an appreciable influence 
on the health of the people residing in the vicinity." Thirty- 
one replies were received. The shameful character of the 
nuisance was denied by none. One physician reported seven 
cases of disease in one year, and added, " Should say the 
condition of the river was a prime factor in their develop- 
ment." Another thought this condition *' might provoke" 
malaria. Another said it " must be unfavorable," though 
neither of these specifies any case of disease. 



394 VAGARIES OF SANITARY SCIENCE. 

Twenty-seven physicians declared that they knew of no 
disease which had been caused by this condition of the 
river, and many of them express the belief that it was in- 
noxious. The opinion of one of these doctors was based 
on an experience of twenty-three years ; that of another on 
thirty years' practice in the neighborhood. This investiga- 
tion showed that the affair was entirely outside the domain 
of the public health. By prosecuting the owners of these 
factories, they, with their millions of capital and thousands 
of operatives, could be driven to another State. The Ne- 
ponset River would then look nicer and smell sweeter. It 
was a question of economics and aesthetics, to be settled, 
not by sanitarians, but by intelligent citizens in town-meeting 
assembled. 

As we are continually reminded by the sanitarians that the 
proof of the efficacy of State medicine is to be found in the 
vital statistics, we naturally turn to those of Massachusetts 
and compare the registration returns since the establishment 
of her Board of Health with those previous to its formation. 
For the twenty years ending 1 869 the general death-rate in 
Massachusetts averaged 1 8.6 per thousand. For the twenty 
years ending 1889 the average general death-rate was 19.7 
per thousand. For the ten years ending 1879 it was 19.9, 
and for the ten years ending 1889 it was 19.6 per thousand. 
Here, as elsewhere, there has been a decrease in mortality 
from certain infectious diseases. The average percentage of 
zymotic deaths to total mortality for forty-eight years ending 
1889 was 25.22. The average percentage for the five years 
ending 1889 was 18.38. This seems to be about the average 
decline of zymotic mortality in our country without regard 
to sanitary measures. 

Small-pox has almost entirely disappeared in Massachu- 
setts in the last ten years. For the previous ten years, 
ending 1879, the deaths from that disease per ten thousand 
of the population had averaged 1.44. 



BOARDS OF HEALTH. 395 

Typhoid and scarlet fevers have also declined, while there 
has been a marked increase of diphtheria. There has been 
also a startling increase of mortality from cancer, heart- 
disease, pneumonia, apoplexy, and Bright's disease, and the 
comfort that we can derive from a study of the vital statistics 
of Massachusetts, in finding ourselves partially saved from 
small-pox, typhoid and scarlet fevers, is entirely swept away 
by the knowledge that we are all the more likely to be car- 
ried off by Bright's disease, pneumonia, heart-disease, cancer, 
and diphtheria. 

The Connecticut Board of Health was established in 
1878. Its organic constitution was like that of Massachu- 
setts, as far as its duties were concerned. It at once issued 
an appeal to the clergy, inviting co-operation, which received 
from that body a most favorable response; and in 1880 it 
congratulated itself that its work had received " the indorse- 
ment by our State medical societies." The board announced 
in unmistakable terms its conviction that the prime cause of 
preventable disease was filth, to the removal of which it 
promptly devoted its energies. Slaughter-houses, offensive 
trades, privies, cesspools, and cemeteries received attention. 
The board superintended the removal of a dead horse near 
the town of Bristol, and the disposal of a heap of clam-shells 
which lay near Milford. For two years it sat in judgment 
on this pile of clam-shells, lest the public health of Connec- 
ticut should be imperilled thereby. In 1886 a physician at 
Unionville reported to the board that the water of a well in 
that town had already caused several cases of dysentery, two 
of them resulting in death. He had forbidden the use of 
the water, but said there was no law to reach the offenders. 
The chemist of the board analyzed this' water and pro- 
nounced it of " good organic purity." 

In 1888 the State Board, in solemn conclave, heard that 
the town-hall at Stamford needed scrubbing, and that the 
secretary of the board had flown to the rescue. The same 



3'96 VAGARIES OF SANITARY SCIENCE. 

year it discussed the building of a cesspool at the State 
Prison. This year the public health had a miraculous 
escape. It was in imminent danger on account of a foul 
urinal on one of the cars of the Shore Line Railroad. The 
secretary, who, fortunately, was on one of his excursions, 
smelled the closet and scented danger to the public health. 
He remonstrated with the conductor, who turned a deaf 
ear, and perhaps laughed in his sleeve. The secretary then 
wrote without delay to the president of the road. Probably 
the latter would have met a labor delegation with an un- 
blanched face, and maybe would have turned his back square 
on a walking-delegate, but he quailed before the sanitary 
terrorist and wrote him " a courteous letter." 

The board was deeply stirred over the sanitary condition 
of the summer resorts in Connecticut. It made frequent 
visits to them. With the artlessness of the callow youth 
who recounts his first travels to the interested parent at 
home, the board, in its reports, told the Legislature of Con- 
necticut how it commended some resorts, and found others 
in a dangerous condition ; all, however, were in equal health. 
It told the Legislature, also, how the inspectors of the board 
were fawned on by the proprietors of these resorts, who 
knew only too well the power of these visitors to empty their 
houses of guests, by intimating with a wry glance that bac- 
teria might be prowling in the remains of yesterday's dinner. 

Year after year seven Connecticut gentlemen, who have 
been engaged in the serious affairs of life until they have 
passed middle age, meet quarterly or oftener, at the call 
of their secretary, and discuss these and similar questions, 
without a sign of laughter. 

The board seems oppressed with a sense of its respon- 
sibility. It says, in the report for 1888, that a well-organized 
Board of Health is as necessary for the safety of the lives 
of a community, as is a fire department for the safety of 
property. Just as a conflagration could be extinguished in 



BOARDS OF HEALTH, 397 

its beginning, so could an epidemic, by equally prompt and 
well-known means. 

But suppose that the fire-brigade were continually giving 
out false alarms ; and suppose that when a genuine one was 
sounded the brigade should yoke its steeds, and, with shout 
and whip and spur, dash away like mad in the opposite direc- 
tion, and suppose that, after the fire was spent for want of 
material, the aforesaid brigade were to make a report to the 
authorities, detailing their alacrity in extinguishing the flames, 
and asking for an increased appropriation for the fire depart- 
ment. This is what the sanitarians have done, and are every- 
where doing, respecting disease. 

From the vital statistics of Connecticut we learn that for 
the fourteen years preceding the formation of her Board of 
Health, the average annual death-rate was 16.3 per thousand. 
For the fourteen years ending 1890 which followed its or- 
ganization, the average annual death-rate was 16.9 per thou- 
sand. Let us scan these returns a little closer. If we assume 
that it required five years for the board to get into working 
order, so that it had subdued the causes of preventable dis- 
ease, it will be fair to compare the last nine with the first 
five years' work of the board. The average annual death-rate 
for the five years ending 1881 was 16.2 per thousand. The 
percentage of zymotic to total mortality was 23. The per- 
centage of infant to total mortality for five years ending 1883 
was 29.9. The average annual death-rate for the nine years 
ending 1890 was 17.50 per thousand. The percentage of 
zymotic to total mortality average, the last seven years, 20.82. 
The percentage of infant to total mortality for six years 
ending 1889 was 30. Yet all over the State panics had 
been fomented, health laws were in operation, prosecutions 
without number had been carried on, fines had been imposed, 
imprisonments threatened, privies and cesspools cleaned, bad 
wells closed, and sanitary improvements pushed to their 
fullest extent, except in New Haven, which was destitute of 

34 



398 VAGARIES OF SANITARY SCIENCE, 

sanitary law, and soaked with filth, but which made a better 
showing, both in the general death-rate and decline of 
zymotic mortality, than any other part of the State. 

The New Hampshire Board reported in 1891 that much 
sanitary improvement had been going on in that State ; 
many causes of disease, and especially of zymotic disease, 
had been removed. Many bad wells had been suppressed ; 
pure water had been introduced, and sewerage had been ex- 
tended in the cities ; nuisances had been carefully watched, 
and many had been removed. Sanitary codes had been 
formed, and sanitary laws properly enforced. We turn to 
the vital statistics to see the effect of these measures. In 
the seven years since registration commenced, the number 
of deaths from zymotic disease was for — 



1884. 


1885. 


1886. 


1887. 


1888. 


1889. 


1890. 


967 


890 


1095 


1073 


1097 


II72 


II55 



The population of New Hampshire was 346,991 in 1880, 
and 376,530 in 1890. There has been an almost steady and 
continuous rise in the deaths from zymotic disease in that 
State as the so-called causes of such disease have been 
removed. The average general death-rate for three years — - 
1884-85-86 — was 17.33 per thousand. The board had been 
in existence five years in 1886, and had got well into oper- 
ation, so far as sanitary codes and the adoption of sanitary 
measures were concerned. For the next four years — 1887- 
88-89-90 — the average general death-rate was 18.39 P^^ 
thousand. The percentage of zymotic to total mortality for 
three years — 1884-85-86 — was 16; for the next four years 
it averaged 17.9 per cent. 

For the fourteen years previous to the formation of the 
Rhode Island Board of Health, the death-rate in that State 
averaged 16.6 per thousand. For the next fourteen years 
the average death-rate was 18 per thousand. For the seven 
years ending 1883, Rhode Island's death-rate was 17.7. For 



BOARDS OF HEALTH, 399 

the next seven years, after sanitary laws and measures were 
in full operation, her death-rate was 19 per thousand. 

New York's State Board of Health was founded in 1881. 
Its duties, like those of the boards of Massachusetts and 
Connecticut, were to investigate the causes of disease, espe- 
cially epidemic disease, etc. It took the same active measures 
for the removal and the suppression of filth. Whenever dis- 
ease broke out in any town it could almost always find a 
privy or some slops or a pond or a bad well. If these failed, 
the resource which never failed was the " filthy condition of 
the soil." It was a little baffled in 1889 when an epidemic 
of typhoid fever broke out at Richfield Springs. Richfield 
has " a bill of health so clean as to put most of our village 
sanitary bureaus to the blush." Its system of water-supply 
and sewerage is " surprisingly satisfactory." " Provision is 
made for the rapid carrying off of surface-water and all forms 
of sewage. No unclean beasts are allowed within its borders 
during the warm season, and the suggestions of the State 
Board of Health are carried out to promote the salubrity of 
the township." High up among the hills, it has " a salubrious 
climate and healing waters."* Yet in this favored spot ty- 
phoid fever broke out. The State Board re-examined the 
town, thinking, perhaps, that previously it had overlooked 
something that now might account for the epidemic. The 
board reports that **the inspection showed an excellent 
sanitary condition." But its faith in the filth-doctrine of 
disease is still firm. 

In the ninth report we are told that its methods for doing 
sanitary work are perfected, and it is " capable of meeting 
any emergency and putting down any epidemic disease 
almost before its presence is appreciably felt, and without the 
slightest disturbance to the business interests of the Common- 
wealth." The very next year the influenza appeared in New 

* Dr. Nott, in Harper's Magazine ^ August, 1884. 



400 VAGARIES OF SANITARY SCIENCE. 

York and spread over the country, causing directly or indi- 
rectly a greater number of deaths and a larger amount of 
distress than any other epidemic which had ever visited this 
continent since its discovery. An excess of five thousand 
deaths above the average number for the State of New York 
is reported for the month of January alone, which is ascribed 
to the effects of the influenza. There is no evidence that the 
board made any effort towards " putting down" this epidemic, 
or even made an inquiry into its cause. It remarks that the 
board is not in a position to deny or affirm to what it is due, 
and adds, '' it is not a filth-disease." This last is a most 
impudent assertion, for, for anything the New York State 
Board of Health knows, it may be a filth-disease pure and 
simple. The board, however, disposes of this desolating 
epidemic with the profound reflection that " it will soon, 
doubtless, come to an end, but will not soon be forgot- 
ten." Although the same epidemic raged in New York 
for two subsequent years, the Board of Health did not 
make the slightest effort to ascertain its cause or arrest its 
progress. 

The vital statistics show that New Jersey is not made any 
worse, at least, by sanitary law. The average death-rate in 
that State for the last thirteen years has been 19.13 per 
thousand. For five years ending 1883, it averaged 1946, for 
the next five years 18.72, and for the three years following it 
averaged 19.23 per thousand. 

The Pennsylvania Board of Health was established in 
1885. In its first report it paid its addresses to woman, and 
especially desired that she should take an interest in the 
problems of sanitation. The emotional character of Sanitary 
Science, and the flattering insinuation that here she might 
find her true sphere, never failed to command woman's sym- 
pathies and active endeavors. In subsequent reports the 
Pennsylvania Board does not say what co-operation it re- 
ceived from the gentler and better sex. Like the other 



BOARDS OF HEALTH. 4OI 

State Boards, it refused all compromise with filth, and 
announced its decision to exterminate it. 

The Michigan Board was one of the earliest that was 
founded. Its reports abound in essays from physicians, 
clergymen, and ladies, who strive for precedence in main- 
taining the sanitary excitement. Michigan's Board was no 
less uncompromising in its attitude towards filth, which it 
faithfully beHeved was the great generator of disease. In a 
former chapter (chapter iv.) we have given some copious 
extracts from the reports of that board. 

The sanitary delirium swept over Minnesota and other 
Western States, and spread to Colorado and the Pacific. 
The health-officer * of one of the important cities of Minne- 
sota, in relating to the State Board the difficulties which beset 
him, says, not, that much has been accomplished through 
investigation and experiment, but that " much has been ac- 
complished through terrorism^ Colorado reports a scathing 
epidemic of typhoid fever at Denver. The city is hardly ten 
years old ; but there are cesspools there, and the cause of 
the disease is the saturation of the soil with filth. One in- 
credulous and daring citizen sneers at this theory of the origin 
of the epidemic, and opens a communication between his 
house and cesspool, with an untrapped six-inch pipe. His 
family consisted of ten persons ; they enjoyed the best of 
health during the epidemic. 

In looking through the health reports of a dozen of the 
more important States, one is amazed at their barrenness in 
everything pertaining to the object for which boards of 
health were founded, — namely, care of the public health. 
All of them cling with an abject fondness to the tradition 
of the filth-origin of epidemic disease. They refuse to 
consider any other cause. None of them (if we except the 
Massachusetts Board) prosecutes any researches into its 

* Minnesota Board of Health Report, 1883-S4. 
aa 34* 



402 VAGARIES OF SANITARY SCIENCE, 

etiology that deserve to be called scientific. Two or thiee 
times, in investigating epidemics, the Massachusetts Board 
has come very near abjuring the old faith, and confessing 
its agnosticism respecting their causes ; but to do so would 
be the first step towards winding up its affairs and going 
out of business. That this board has dealt with more fair- 
ness and intelligence, and with less apparent self-seeking, — 
especially in its earlier years, when it was animated by the 
Pagan maxim, — than any other, is plain to him who will 
take the trouble to compare its reports with those of other 
State boards. Indeed, if we except a few valuable essays 
in the Massachusetts reports, and two or three scholarly 
papers which are hid away in those of Connecticut, there is 
hardly anything in the pile of turgid volumes which make 
board of health reports in our country that possesses any 
scientific interest. They are full of empty boasting, loose 
assertion, idle conjecture, vain declamation, and abominable 
rhetoric. They are important only as they are bulky with 
facts which prove that the very basis of so-called Sanitary 
Science is a sham. The facts which its professors adduce 
place them in the light of a public prosecutor, who is pur- 
suing an offender against the law, and supports the charge 
against him with the most villifying oratory, and at the 
same time proceeds to vindicate the defendant by intro- 
ducing witness after witness to prove the falsity of the original 
indictment. They loudly proclaim the filth-origin of dis- 
ease, and then heap evidence mountain high that shows the 
theory to be untrue. 

There is no sign in any of these reports that a health 
board has ever foreseen an approaching pestilence that was 
not manifest to the ordinary citizen, or has ever added a 
particle of information to elucidate the causes of epidemics, 
or that the efforts and laws of any health board on the ar- 
rival of an epidemic ever modified its influence, abated its 
virulence, or prevented its return. We are constrained to 



THE VITAL STATISTICS. 4O3 

repeat what Mr. Webster said a century ago, in his ex- 
haustive study of epidemics, and which is rendered more 
certain by the investigations of the plague by Dr. Tholozan 
and by the history of all wide-spread epidemics of the last 
hundred years, — that there is " no sufficient evidence that 
health laws ever saved a country or city from pestilence in 
a single instance, but abundant positive proof of their 
utter inefficiency in a great number of cases." 

Note In a foreign port during the autumn of 1892, it was the author's 

privilege to witness the process of fumigation under sanitary order. A large 
number of passengers had sought this port to embark for the United States, be- 
cause it was free from cholera. They were obliged to send their trunks to be 
fumigated twenty-four hours before sailing. This order caused them great an- 
noyance and extra outlay, and, besides, it was an expensive operation for the 
steamship company, each fumigation costing, the agent said, four hundred dol- 
lars. Though these passengers had arrived from cholera-infected districts, they 
were allowed to take on board, without fumigation, all valises, hand-bags, rugs, 
and loose clothing. The trunks only were fumigated, and these were not 
opened. Nothing could be more ridiculous. While the fumigation proceeded, 
the company's agents laughed, the consul who made the certificate laughed, the 
doctor who superintended the operation laughed ; the joke was of such mag- 
nitude that the very passengers who had suffered the inconvenience and extra 
expense joined in the merriment. After the doctor's jollity had subsided, he 
said that the ceremony was beneficial, in that it quieted the fears of the people, 
increased their respect for Sanitary Science, and heightened their reverence 
for its professors. 



CHAPTER XVIII. 

The Vital Statistics. 

In this chapter the author makes no attempt to throw 
any new light on the subject of vital statistics, his object 
being to show that these, which the sanitarians so boast- 
ingly display for their vindication, not only offer no support 
to Sanitary Science, but, when carefully examined, show 
incontestably that the so-called sanitary measures of the 



404 VAGARIES OF SANITARY SCIENCE. 

reformers have been utterly futile in the prevention of infec- 
tious diseases, and that these have spontaneously disap- 
peared time and again when no such measures have been 
undertaken, while, on the other hand, they have arisen and 
increased in number and virulence in the face of the most 
rigid efforts to prevent them. 

There are certain laws governing the mortality of man- 
kind which are fixed and unalterable by human provisions. 
The law of heredity is well recognized by all physicians, 
but it is not sufficiently understood to permit any very posi- 
tive conclusions. The law of sex is universal so far as we 
have any information. We know that death strikes the 
male child i7t utero oftener than it does the female, and that 
the advantage gained by the latter in conception is held for 
the first five years after birth to such an extent that it need 
not be despised as an element of prognosis in many acute 
diseases. This advantage of the female is no longer main- 
tained after five years ; the chances of life are now about 
equal for the two sexes, and remain so until the approach 
of puberty, when they are diminished materially for the fe- 
male. After puberty the male continues to have a slight 
preference during the activity of the child-bearing period of 
the woman, when, as her climacteric arrives, the condition 
is again reversed, and she resumes the advantage of lon- 
gevity, and retains it until the generation which we are con- 
sidering will have passed away. On the whole, however, 
the death-rate, at all ages, of males will be nearly a steady 
one of more than two per thousand above that of females. 

Legitimacy seems to be another of the unchangeable laws 
of mortality. The child conceived in the stealth of dishonor 
actually helps to conceal the shame ; it is much more likely 
to be expelled from its mother's womb a mute witness, still- 
born, than is the one conceived in wedlock. If born alive, 
the illegitimate child, on the whole, is about twice as likely 
to die under five years as the one honestly begotten. In 



THE VITAL STATISTICS. 405 

Plymouth, in 189 1, the deaths of illegitimate children under 
one year were 330 per thousand, as compared with 180 per 
thousand of those born in wedlock. In Brighton the cor- 
responding figures were 293 per thousand of illegitimate 
and 118 legitimate. In Blackpool there were 382 illegitimate 
deaths and 169 legitimate deaths per thousand under one 
year. There are certain districts in some countries where 
the difference in mortality between legitimate and illegitimate 
children is frightful, being three or four times greater with 
the latter than with the former. That illegitimate children 
are not reared with the same care that the others are is true, 
but this is not enough to explain the enormous difference in 
the relative mortality. 

The vital statistics of our own country show that race not 
only has a positive influence in the development of certain 
diseases, but that the mean duration of life differs rather 
widely for different races. There are certain diseases which 
destroy the black race in much greater proportion than the 
white ; while there are others which augment the mortality 
of the white race from which the black race is comparatively 
exempt. The Hebrews present, probably, the most remark- 
able example of the influence of race, both in the protection 
it seems to afford against certain diseases as well as in the 
promotion of general longevity. That they largely escaped 
the blasting epidemics of the Middle Ages was the ground- 
work for suspicion that they in some way caused their 
spread among the people. Within the last century it has 
been pretty nearly proved that the Jews everywhere not only 
enjoy special immunity from epidemics, but that the mean 
duration of life is longer among them than it is among any 
other race of civilized men. This difference is shown to be 
so great in our own country * that if it were not carefully 
substantiated it would be incredible. It is here proved that 

* Census Bulletin No. 19, 1890. 



406 VAGARIES OF SANITARY SCIENCE, 

the expectation at birth of life for the Jews is sixty-one 
years, while in Massachusetts the expectation of life at birth 
is not quite forty-three years ; and that of one hundred 
thousand born for the Jews one-half would be living at the 
end of seventy years, while of one hundred thousand born 
in Massachusetts one-half would be dead in less than fifty 
years. Careful studies of this race in Germany, Italy, France, 
England, Africa, — indeed, in every part of the world, — 
show that it possesses about the same superior longevity as 
is shown by Census Bulletin No. 19. 

The sanitary orator tells us that this superiority of health • 
and life of the Jews is accounted for by the Mosaic sanitary 
code ; that this inculcates cleanliness and the removal of 
filth ; that the meat which is eaten by the Jews is inspected 
by a priest ; that the walls of a house are cleansed after a 
case of leprosy, and that the diet of the Jew is sedulously 
guarded ; that he washes his hands before eating ; that Sani- 
tary Science, in fact, carefully extended for forty centuries, 
has conferred on the IsraeHte this longevity and immunity 
from disease. 

Is it a fact that the Jew is more cleanly than other people, 
that he is more frequent and regular in his ablutions than 
the Mohammedan and the Christian ? Is it more efficacious 
to scrape the walls of a house after a case of contagious 
disease than to do as we do, — namely, fumigate the rooms 
with sulphur and carbolic acid ? Does the resistance of the 
Jew to disease depend on his eating the pygargand refusing 
the ossifrage, as the Mosaic code imposes; or is the Jew 
healthy because he regales himself with the grasshopper 
and the locust, — and the bald-locust, — but despises the 
humble oyster, the lobster, and the eel, and abhors every 
creeping thing that creepeth ? If it be true that he is freer 
from disease and longer-Hved than other men, is it not rather 
that it is because he is a born master ; that he has been tried 
and toughened in the fires of persecution, and that, though 



THE VITAL STATISTICS. 407 

trodden under foot of men for centuries, yet, through craft 
and cunning, — genuine statesmanship, — he has kept his race 
pure and himself in the ascendant in all that pertains to the 
intellectual man, and because he is more temperate, sober, 
and virtuous than other men ? Are not his days lengthened 
because he honors his father and mother, and rests on the 
Sabbath-day ? Drunkenness is a vice almost unknown 
among the Jews, and one of them is rarely convicted of 
crime. Does not this longevity, in great part, depend on 
the fact that the Jew is slow and careful in entering the 
married state, and that when he has taken on himself this 
condition he is prudent in begetting offspring ? 

The birth-rate of Jews in our country is given in the bul- 
letin alluded to as less than twenty-one per thousand, while 
that for the whole country is about thirty-one per thousand, 
which indicates that the Jew, perhaps without being con- 
scious of it, comprehends and practises the mild and humane 
philosophy of Malthus, which teaches that mere sexual irri- 
tability and sexual energy no more impart power and respec- 
tability to a nation than to an individual. 

One of the most constant laws of mortality is density of 
population ; everywhere people in rural life yield a death- 
rate of from three to six less per thousand than the inhabi- 
tants of cities, though these show a wide range of death- 
rate in different localities, illustrating another constant law 
of mortality, — that people surrounded by ease and comfort 
enjoy a superior longevity. Mortality is, again, regulated 
by civil condition. Marriage is much more favorable to 
long Hfe than celibacy, although its influence varies widely 
for the two sexes. The registration returns of Scotland 
show that the comparative longevity of single women is 
much more assured than is that of single men, proving that 
man is much more dependent on his helpmeet for length of 
days than the woman is on man. From the fifteenth to the 
thirtieth year, the usual period of giving birth to the first 



408 VAGARIES OF SANITARY SCIENCE. 

infant, married women die in greater proportion than single 
women. From the thirtieth to the fortieth year the death- 
rate is sHghtly higher among unmarried than among married 
women. From forty to forty-five years they fare about ahke 
as regards longevity, but from forty-five to seventy-five the 
difference is decidedly in favor of married women, there 
being 12.99 <^ea-ths of married women per thousand living 
between those ages, against 14.80 per thousand of unmar- 
ried women. With men the influence of celibacy is very 
striking. From twenty to twenty-five years, 6.80 per thou- 
sand living of married men die annually, while twelve per 
thousand Hving of those die of the unmarried. From 
twenty-five to thirty, 8.29 die per thousand of the married, 
and 14.32 of the unmarried. The corresponding figures for 
the married and unmarried men between thirty and thirty- 
five years are 9.60 of the first and 15.51 of the second, and 
from thirty-five to forty years 11.62 per thousand of the 
married die annually, and 16.85 ^^ the unmarried. From 
fifty to seventy-five years, 44 per thousand living of the 
married die annually, and 55 of the unmarried. These 
observations, which were continued over a period of many 
years in Scotland, seem almost incredible, but they are en- 
tirely corroborated by the inquiries of Bertillon concern- 
ing the effect of celibacy in France, Belgium, and Hol- 
land. 

It may be said that there is hardly a law of mortality, 
which is influenced at all by human agency, that does not 
admit of some important exceptions. Race, sex, age, celi- 
bacy, legitimacy, density of population, profession, and oc- 
cupation offer probably the fewest exceptions. In surveying 
the mortality tables of nations, education seems to have a 
certain influence on human longevity. The death-rates of 
educated Prussia and Belgium are much lower than those 
of ignorant Austria and Italy. But uninstructed Ireland 
has a lower death-rate than enlightened Scotland and Eng- 



THE VITAL STATISTICS. 4O9 

land. Civil and religious liberty seem to exercise a favor- 
able influence on a nation's death-rate. This is, in general, 
lower in Protestant than in Catholic countries, and it might 
be argued from this fact that the insurrection of Martin 
Luther was a great sanitary measure and himself an Emi- 
nent Sanitarian. But Catholic Belgium has a lower death- 
rate than Protestant Prussia, and bitterly oppressed and in- 
tensely Catholic Ireland shows for the last thirty years a 
more favorable death-rate than free England, Protestant 
Sweden, educated Prussia, or any other civilized people on 
the earth. 

In general, those countries which have a large proportion 
of illegitimate births, like Austria and Italy, show a high 
death-rate ; but Denmark, Sweden, and Scotland furnish as 
great a proportion of illegitimate births as Italy, yet the 
number of deaths in those three countries is from twenty to 
thirty per cent, below that of Italy. 

The extreme prudence, in forming conclusions, of those 
philosophers who have profoundly studied the subject of 
vital statistics, contrasts strangely with the reckless, hap- 
hazard, unscientific manner with which they are treated by 
the sanitarians. The same discomfiture attends these in 
their consideration of rates of mortality as in their elucida- 
tion of the principles of Sanitary Science. Indeed, the re- 
formers tell us that the question of longevity is, like that of 
great pestilences, purely one of efficient scavengering, and 
that sanitary condition — that is, the prevention of zymosis — is 
the great law of mortality ; and that by sanitary measures — 
that is, the removal of filth — the progressive decrease of the 
death-rate of mankind is to be maintained. 

They stake the value of sanitary reform and so-called 
sanitar}' measures on the vital statistics, and parade them 
without reference to any of those almost innumerable con- 
ditions which affect the comfort, well-being, and, indirectly, 
the longevity of the race, and which the intelligent and re- 



41 VAGARIES OF SANITARY SCIENCE. 

fleeting physician or hygienist does not fail to consider in 
the study of mortality tables. 

It is fortunate if, through ignorance or design, these are 
not grossly misrepresented by the reformers. A report of 
the board of health of a large city lies before the author, 
which professes to give the vital statistics and the conditions 
of life and health in that town. It calls attention to the 
fact that in one ward the death-rate is from twenty-two to 
twenty-four, while in another it is only twelve or thirteen 
per thousand. Besides, the infant death-rate, that sen- 
sitive test of sanitary law, is extremely low in the latter 
ward. Here, the report says, sanitary measures are per- 
fected, cleanliness prevails, and these statistics are exhibited 
to show in particular the advantages of good plumbing, and 
the importance that this should be extended throughout the 
city by plumbing-laws, and that plumbing-inspectors should 
be appointed. Not a hint is given in this report that the 
board which issued it had the slightest knowledge that there 
are other distinctions in these wards ; that the ward with 
the low death-rate contains proportionately three or four 
times as many people between the ages of fifteen and forty 
years as the other ward, or that a male-student population — 
instructors, undergraduates, graduates, and celibates — con- 
stitute at least two-fifths of the people in the former ward, 
or that the birth-rate in that ward is ten or twelve, while 
that of the other is thirty or forty per thousand. 

Nowhere in this report does the board which issued it 
betray the least knowledge of the fact that in the ward with 
the high death-rate idleness, poverty, ignorance, debauchery, 
severe labor, imprudence, overcrowding, intemperance, and 
violence abound, while the other ward is noted for its small 
families, roomy houses and yards ; for ease, comfort, intel- 
ligence, prudence, and sobriety. Yet documents like these 
are yearly emitted for the instruction of the people, and to 
inform scientific men of the progress of Sanitary Science, 



THE VITAL STATISTICS. 4II 

and from such reports the sanitary elocutionist draws the 
inspiration and material for his public discourses at sanitary 
convocations. 

As evidence of the value of Sanitary Science its profes- 
sors summon us to behold the striking difference in human 
longevity between present and past times ; that the death- 
rate, which in the sixteenth and seventeenth centuries was 
fifty, sixty, seventy, and in epidemic years even eighty per 
thousand annually, is now, through the adoption of sanitary 
measures, reduced to twenty-four, twenty, and even fifteen 
per thousand. In listening to the sanitary orator, or in the 
perusal of sanitary literature, one would never guess that 
the reformers had any knowledge whatever that the general 
death-rate was steadily decreasing and the mean duration of 
life as steadily increasing for two hundred and fifty years be- 
fore the great sanitary uprising. According to their story the 
air, water, and soil had been undergoing a saturation with 
filth as civilization advanced and population augmented, and 
it was only by a kind of miraculous circumstance that the 
evolution of the Eminent Sanitarian just at the right mo- 
ment saved the world from destruction, and that decrease in 
the general death-rate corresponded to the rise and progress 
of Sanitary Science. 

The fact is, that proof is at hand which clearly demon- 
strates that there was a greater proportional decline in 
death-rate for two hundred and fifty years before than there 
has been since the sanitary excitement, and that it was spe- 
cially marked in infant mortality and in that from so-called 
zymotic disease. The vital statistics of Geneva reach back 
to 1549. Here was a mediterranean city whose population 
was little affected by emigration or immigration. In 1543 
it had thirteen thousand people; this number was not 
doubled until 1828, nearly three hundred years later, when 
it had twenty-six thousand inhabitants. It therefore pre- 
sented a field for the study of mortality rates, which, though 



412 VAGARIES OF SANITARY SCIENCE. 

not very extensive, was adequate to give correct information 
of progressive longevity, and M. Mallet says Geneva during 
those three hundred years may be considered as a fragment 
of the grand total of civilized mankind as regards vital sta- 
tistics. He shows that the mean duration of life in the six- 
teenth century was eighteen years, in the seventeenth it was 
twenty-three years, in the eighteenth it was nearly thirty- 
three years, and in 1830 it was more than forty years. The 
great betterment in the duration of life during these three 
hundred years lay. Mallet says, in the diminution of infant 
mortality, — this being in 1830 only one-half what it was in 
the sixteenth century, — and in that from contagious dis- 
ease, and these results are largely attained by the lessened 
birth-rate. Now,* he says, the marriage age is late ; fecun- 
dity is at its minimum in Geneva ; but longevity is greater ; 
no city counts so few births and so few deaths, and her 
prosperity is a powerful aid to the argument of Muret, that, 
" La force de la vie dans chaque pays est en raison inverse 
de la fecondite," and of Ivernois, who declared that, " Si les 
hommes vivent plus longtemps il en nait un moins grand 
nombre." 

Among the causes of this increased duration of life, 
Mallet enumerates, aside from the lower birth-rate, the 
cessation of epidemics like plague, a general improvement 
in the ease of the people and in medical science, better 
houses, more abundant and better food, vaccination, clean- 
liness, precaution against famine, a higher intelligence, and 
a higher morality. In France, Dr. Aubrien studied the vital 
statistics of the commune of Gault for two hundred years. 
The results are almost exactly like those of Mallet. From 
1690 to i^cxD the death-rate of Gault was thirty-nine per 
thousand. From i860 to 1874 the deaths there were only 
sixteen per thousand. Gault, like Geneva, was favorable 



1833. 



THE VITAL STATISTICS. 413 

for a study of this kind, because its population has not 
varied materially for two hundred years. Dr. Aubrien says 
that infant mortality is not more than one-third of what it 
was two hundred years ago ; fecundity is less than one-half. 
But he says if less are born here in Gault they are better 
preserved. 

Dr. J. L. Casper* showed that during the previous hun- 
dred years the mean duration of life in ten of the principal 
capitals of Europe had increased ten years, and that in Lon- 
don it had increased nearly twenty years. Dr. Casper set 
forth the proposition that the proportion of births to the 
population expresses almost exactly the mean duration of 
life; that in Prussian districts, where there is the largest 
number of births, this duration is 28.9 years ; and in those 
districts where there is the least number of births, it is 32.6 
years. In the most fertile parts of the Low Countries, where 
there is one birth to twenty-four, there is one death to 36.9 
of the people ; while in those provinces where the births 
are one to twenty-eight, the deaths are one to forty-nine 
inhabitants. He found a difference of six years in the dura- 
tion of life between the most fertile and least fertile districts 
of France. The same condition prevailed in Belgium, Switzer- 
land, and England ; and in Russia, where the births are more 
numerous than in any other country (being between forty 
and fifty per thousand inhabitants), the mean duration of life 
was only twenty-one years. Dr. Casper says the law is that 
fertility is the regulator of mortality (Die Fruchtbarkeit der 
Regulator des Todes) ; that the duration of life increases or 
diminishes according as the fecundity is greater or less; 
showing that nature remedies an excessive fertility that may 
be detrimental to the next generation, and that man, through 
being placed in easy circumstances, — ease and vitality being 
synonymous terms, — by regulating the fertility of the race, 



1835. 
35* 



414 VAGARIES OF SANITARY SCIENCE. 

by the practice of virtue, by industry, sobriety, and economy, 
can control to a certain extent the duration of his own life, 
and become " der Herr seines Lebens," and that no doctrine 
is more pernicious (verderblicher) to the common welfare 
than the admonition, " Be fruitful and multiply." He showed 
that twice as many rich attain the age of seventy as poor, 
and that the mean duration of life for princes and counts 
was fifty, while that of beggars was only thirty-two years. 

Dr. Casper called attention to the fact that locality had 
little to do with longevity ; that the wet lands, foggy and 
moist atmosphere of many of the countries bordering on the 
northern seas differed widely from the dry, sandy plains of 
Brandenburg, but that the difference in the mean duration of 
life was almost nothing. 

Quetelet noticed the same increase in longevity and the 
same relation existing between births and deaths as did 
Mallet, Aubrien, and Casper. He says in Brabant and the 
two Flanders, " II meurt et il nait le plus d'individus ;" Great 
Britain produces less than our country (Belgium), yet her 
fruits are more durable ; fewer people see the light there, but 
those who do are better preserved, and if fecundity there is 
less, the utility of the people produced is greater. We can- 
not too often repeat, says Quetelet, that the prosperity of a 
state consists less in the multiplication than in the preserva- 
tion of the individuals of which it is composed. 

The Swedish life-tables show the progressive longevity in 
that country previous to the era of sanitary reform. The 
death-rate there for twenty-one years, 1755-75, was twenty- 
eight per thousand ; for twenty years, 1776-95, it was twenty- 
six ; and for twenty years, 1810-29, it was twenty-four ; and in 
1840 it had fallen to twenty-three per thousand annually. 
France shows the same progressive diminution of death-rate. 
In the sixteenth century the mean duration of life in that 
country was seventeen years ; in the eighteenth century, as 
late as 1789, it was twenty-eight years ; in 18 17 it was thirty- 



THE VITAL STATISTICS, 415 

one; and in i860 it was about thirty-eight years. The mor- 
tality in France previous to the Revolution was more than 
forty per thousand annually. Between iSi/and 1836 it had 
fallen to twenty-five per thousand. We might reason from 
this that the French Revolution was a great sanitary measure, 
and that when Dr. Guillotine invented his deadly instru- 
ment he provided something which was favorable to human 
longevity. 

The death-rate in Denmark in 1800 was 29.8 per thousand. 
It fell continuously, except in epidemic years, until in 1842 
it was 20.5, and in 1885 it was 17.9 per thousand. In 1891 
we are told * that less than two-thirds of the communes, out- 
side of Copenhagen and sixty-six large towns, have no sani- 
tary laws, and the sanitary measures which have been 
undertaken in the towns seem to be accompanied with no 
diminution of contagious disease. Diphtheria, which in 1870 
caused one hundred and ten deaths in the cities, destroyed 
nine hundred and seventy-five people in 1889. One physician 
says, t " It is remarkable, considering the advance of public 
and private hygiene in Denmark during the last thirty years, 
that the mortality of those periods of age most liable to epi- 
demic diseases, against which hygiene mostly directs its 
efforts, is not influenced by sanitary improvements." 

Turning to Great Britain, we have ample and complete 
evidence of the steady gain in human life for two hundred 
and fifty years before the sanitary excitement. In London 
the average mortality in the middle of the seventeenth cen- 
tury, not counting still-born, was fifty per thousand. This 
represents the mortality of years free from pestilence, but not 
the absolute mortality, which for twenty- four years, 1620-43, 
was seventy per thousand. From 1660 to 1679 ^^^ death- 
rate was eighty ; from 1728 to 1757 it was fifty per thousand. 



* Denmark : Its Medical Organization, Hygiene, and Demography. 
f Ibid., p. 426. 



41 6 VAGARIES OF SANITARY SCIENCE. 

and continued so until 1780. Between 1801 and 18 10 Lon- 
don's death-rate had fallen to twenty-nine, rising again to 
thirty-two per thousand in the five years, 1831-35, which 
period included the cholera epidemic of 1832. The per- 
centage of infantile to that of total mortalit}^ in England was 
seventy-four between 1730 and 1749; twenty years later it 
had fallen to sixty-three, and in 18 10 it had declined to 
forty-one per cent. Dr. Farr says, " If the Carlisle obser- 
vations even approximately represented the mortality of 
England, the waste of life in the five years of infancy has 
almost diminished one-half during the last hundred years ; 
other observations support this probability." According to 
Dr. Price's tables, the average death-rate at all ages in North- 
ampton for the forty-five years, 1735-80, was thirty-four per 
thousand, and this probably very nearly represented the 
mortality of England and Wales at the time. In 1841 the 
death-rate in England had fallen to 21.6 per thousand. 
The mean duration of life in England in 1735 was about 
thirty years; in 1845 it had increased to about forty years. 
Dr. Farr estimates that the death-rate for England for eigh- 
teen years, 1813-30, was about 21.2 per thousand. So far 
as we have material to form an opinion, it is probable that 
the conditions of life and health in Great Britain had been 
for a long time more favorable than those of any continental 
state except Norway and Sweden. 

We see that for nearly three hundred years the death-rate 
in all civilized countries was steadily declining, and that the 
falling off in mortality was principally in infant deaths, and 
in those from contagious disease. Yet during those three 
hundred years the sanitarians tell us that the precise causes 
of such mortahty were accumulating, and it was not until 
about 1840, when the aurora of Sanitary Science appeared, 
that any effort was made to remove them. 

Since 1838 there has been a complete system of registra- 
tion of vital statistics in England. The sanitary movement 



THE VITAL STATISTICS, 417 

began about the same time, and it is extremely interesting to 
note its progress and its influence on the death-rate in that 
country for the next forty years. For the three years, 
1838-40, the death-rate for England was 22.4 (it was 21.8 in 
1839) per thousand. 

From 1841-45 the death-rate was 21.4 From 1861-65 ^^^ death-rate was 22.6 



1846-50 " " « 23.3 

1851-55 " " " 22.7 

1856-60 " « « 21.8 



An average of 22.1 per thousand 



[866-70 " « " 22.4 
1871-75 " " " 22.0 
1876-80 " " « 20.9 



In 1876-77-78-79-80 the death-rate was 20.9, 20.3, 21.6, 
20.7, 20.5, being in 1878 almost exactly what it was forty 
years before, in 1839, when it was 21.8. In 1845-50-56 it 
was 20.9, 20.8, 20.5. It was never so low again for more 
than twenty years. Registration shows the amazing fact 
that for nearly forty years there was practically no diminu- 
tion of death-rate in England, notwithstanding the fierce 
sanitary excitement, the sanitary laws and persecutions. 
This is all the more astonishing when we observe that, 
except the Crimean war, England for those years enjoyed 
profound peace ; that all of those influences which affect the 
well-being of a people, and which are believed, indirectly at 
least, to promote longevity, were in operation there to a 
greater extent than in other countries; that there was a 
steady decrease of illegitimate births ; a steady increase in 
the ages of those marrying, — a sure indication that their 
offspring would be reared with more judgment ; a diminution 
of the hours of labor; a more varied food, and a more plen- 
tiful amount of the same; better wages, clothing, and 
shelter ; a steady decrease in pauperism ; a steady increase 
of education among the common people ; yet the death- 
rate for these forty years showed no tendency to decline. 

As early as 1846 the registrar-general says, " The returns 
prove that nothing effectual has been done to diminish suf- 



41 8 VAGARIES OF SANITARY SCIENCE. 

fering and death. The sanitary improvements have been 
going on. They are showy," he says, " but they have not 
reached the homes and habits of the people." And more 
than ten years later,* he comes near openly expressing his 
doubts of " sanitary improvements," for he says sixty-four 
districts are found in England where reside a million of 
people, and where the mortality ranges from fifteen to sev- 
enteen per thousand ; these people follow agricultural pur- 
suits, do not drink poison in gin-palaces, and their minds 
are not overwrought by dissipation, passion, and intellectual 
effort. But visit their dwellings, and you find "the bed- 
rooms are often small, close, and crowded ; personal cleanli- 
ness is not much studied ; the dirty pig and filth of various 
kinds lie here in close proximity to the house; the land 
there is imperfectly drained; ignorance yields its baneful 
fruits ; medical advice is ill supplied and unskilful ; yet the 
annual mortality of this million of men, women, and chil- 
dren year after year does not exceed seventeen per thou- 
sand." In fact, here was complete proof that in sixty-four 
districts in England a million of inhabitants were exposed 
to what the sanitarians call impure air, water, and soil, and 
yet they enjoyed a condition of health vastly superior to 
that of the country at large, and to that of those districts 
which were not reviled for their uncleanness. 

That these sanitary measures had no influence on disease 
did not escape the eye of the English physicians, but for the 
most part they seemed to have been so cowed by the vio- 
lence of the reformers that they seldom alluded to it in a 
public manner. Dr. Farr, in his letters to the registrar- 
general, which covered a period of forty years, wherein he 
analyzes with a masterly mind the vital statistics of England 
and Wales, hardly alludes to sanitary measures as affecting 
the general death-rate, or that from zymotic disease. In 



.857. 



THE VITAL STATISTICS. 419 

1879 Dr. Fergus * ventures to review the registrar-general's 
reports. He shows that since the sanitary measures have 
been in progress there has been a marked increase in certain 
diseases which are declared to be due to defective drainage 
and filth ; that diarrhoeal deaths, which were only 203 per 
million living in 1838, and which averaged for the next 
five years only 298, had increased for the five years 1867- 
71 to 1 161, and for the five years iZ'j2-j6 they were 998 
per milHon living, annually, and in none of these years 
was there the disturbing element of cholera. Dr. Fergus 
called attention to the fact that deaths from the two fevers — 
typhus and continued — which are not caused by filth and 
by want of drainage, have fallen off in eight years, 1869-76, 
the first from 193 to 49, and the second from 245 to 83 
per million Hving; while the only fever, typhoid, which is 
said to be more than any other due to bad drainage and 
filth had been least affected by the sanitary improvements ; 
that is, its decline in the eight years being only from 390 
deaths to 311 per million Hving. Dr. Fergus dares to 
quote Mr. A. H. Bailey,t who asks if there is any evidence 
that sanitary improvements affect the duration of life ; large 
sums of money have been spent, and what has been the 
result ? "It happens, curiously enough, that in each of the 
three decennial periods the rate of mortality has been iden- 
tical, — namely, 22.35 P^^ thousand of the population." 

In 1874, Dr. Letheby, himself the president of the society 
of medical officers of health,J said, in despair, that there 
were influences outside of the sanitary condition which 
affected the death-rate ; that " for thirty years the public 
health-officers had been working towards improving the 
sanitary condition of the country and the chief towns, par- 



* Medical Press and Circular^ 1879. 

f Journal Institute of Actuaries, 

% Journal Statistical Society, London. 



420 VAGARIES OF SANITARY SCIENCE. 

ticularly the metropolis, and yet they could not touch the 
death-rate. If anything, it had increased. Speaking for 
himself and his brother-officers of health, he could say that 
they had worked for the sanitary improvement of the metrop- 
olis with an earnestness that was hardly to be found in any 
other part of the kingdom, and yet how had that affected the 
death-rate? Between 1841 and 1850 it was 25.29 per thou- 
sand ; in the second decade it was 24.94, and in the third it 
was 25.11. There could be no remedy until medical officers 
of health had given to them unlimited powers to enable them 
to place the poor in exactly the same sanitary conditions as the 
rich!' (Italics ours.) 

In 1875 the death-rate for England and Wales was 22.8; 
the mean rate for thirty-six years, 1838-74, had been 22.3 
per thousand. In so far as we can ascertain, for the previous 
three hundred years, if we except plague-years, there was 
never a period of forty years when there was not a marked 
decrease in the death-rate in England. This halt for forty 
years in the decline of mortality, right in the face of the 
sanitary delirium and persecution, is unaccountable ; there is 
nothing to do but to record the fact. 

The registrar-general now * takes comfort that there has 
been no great increase of death-rate, and he assures us that " it 
is less than it would have been if no sanitary measures had 
been administered.'* He thinks, however, that it would be 
well to consider " how far the mortality is due to inevitable 
causes, and how far to movable causes ;" we must know 
how far epidemic diseases are affected by " meteorological 
conditions," and also inquire " how the germs of some 
zymotic diseases are communicated." Yet for more than 
thirty years we had been told, until our ears were deaf 
from its repetition, that these epidemic diseases were caused 
by filth, and it was only a year or two before that Mr. Simon 



[875. 



THE VITAL STATISTICS. 42 1 

had demonstrated to the satisfaction of all Eminent Sanita- 
rians that the "septic ferment," which was generated in 
filth, was the cause of these diseases. This steady mainte- 
nance of mortality-rates in England for forty years is all the 
more astonishing because elsewhere, in the isles of the Brit- 
ish seas, in Ireland, and on the Continent, the decline of 
disease, and especially of infectious disease, which had been 
going on for three hundred years, was still proceeding, in 
the absence of so-called sanitary measures, sanitary laws, 
and sanitary persecutions. In the island of Jersey the death- 
rate was equally low with that of England ; while that of 
Guernsey was much lower, being an average of 19.7 per 
thousand annually for the decade 1871-80, and 17.3 for the 
decade 1881-90. 

According to a special sanitary survey of the Isle of Man,* 
" a medical officer of health is a being unknown in that 
island ;" there is " a very general ignorance of the duties and 
object of sanitary authorities." Douglas, the chief town, 
which has nearly doubled its population since 185 1, is in the 
worst possible sanitary condition ; the inspector had seldom 
seen a dirtier town. " The state of the narrow streets and 
back yards is horrible in the extreme ; the sanitary condition 
of the houses is as bad as possible, and must render them 
hot-beds of disease." The drinking-water was horribly pol- 
luted; "human excrement was scattered all around the 
public water-supply ;" " I saw such dirt and misery as would 
make the average Englishman shudder." In the more rural 
parts of the island sanitary matters are utterly unknown ; 
" the well-water of the cottages cannot fail to be polluted by 
surface and excremental soakage." The inspector says, " I 
have never seen cottages so generally and so hopelessly 
unsanitary;" it is "a foul blot on the island." But when he 
inquired for disease, and especially infectious disease, he was 

* Sanitary Record, 1879. 
36 



422 VAGARIES OF SANITARY SCIENCE. 

unable to find any. One of the chief medical men told him 
that " diphtheria was a vtry rare disease, and that there had 
not been an epidemic of typhoid fever for twenty years." 
Mr. Cadman * writes that great numbers come to the Isle 
of Man for " health's sake;" long experience had proved its 
salubrity; that "no more healthy country can be found," 
and he shows by the records that the inhabitants there are 
remarkable for their longevity. Turning to the vital statis- 
tics of the filthy island, we find that its population had been 
nearly stationary for thirty years, but that its birth-rate was 
six or eight per thousand greater than its death-rate, showing 
that emigration was considerable. It is fair to presume 
that those who emigrated were young and middle-aged 
people, just the ones to help furnish a low death-rate if they 
had remained. But with the departure of this important 
quantity, we find the death-rate below that of England and 
Wales, and that it was decreasing in the Isle of Man, as in 
the other islands of the British seas, in those years when it 
was stationary in England, and it is notable that the former 
were specially exempt from that class of diseases which 
their " unsanitary condition" is said to produce. Ireland, 
whose sanitary condition is represented to be fully as bad, 
if not worse, than that of the Isle of Man, had a death-rate 
for seventeen years, 1864-80, of seventeen per thousand 
inhabitants. Ireland was destitute of all health laws until 
1878. 

The registration^ of vital statistics in Ireland was begun in 
1866. The returns from that island make a most interesting 
study, not only to the physician, but to the political econo- 
mist. Here was an average population for twenty-five years 
of about five millions. During those years there was an 
average annual emigration of about seventy thousand. Con- 
trary to popular belief, these statistics of the Irish people 

* Sanitary Record, 1879. 



THE VITAL STATISTICS. 423 

show that, illiterate as they are, compared with their neigh- 
bors, fewer among them are married under age ; that they 
have a lower marriage- rate, a lower birth-rate, a lower rate 
of illegitimacy (this being not one-half that of England, and 
not much more than one-fourth that of Scotland), and a 
lower death-rate than any other people except, perhaps, the 
Jews. None of these low rates can be explained by the 
emigration of only seventy thousand annually of that portion 
of the people who are likely to marry and bear children. 
The average annual death-rate for twenty-five years was 
about 17.5 per thousand. The condition and surroundings 
of large portions of the Irish people were so base that the 
average Englishman would have been ashamed to stable his 
horses or kennel his dogs among them. Dr. Tucker * 
describes the sanitary condition of the home of a noble- 
man's tenant : " The domestic circle consisted of a sick man, 
his wife, four daughters, one son, three cows, one horse, two 
calves, two pigs, and poultry, all in one common individual 
house ; generally the pigs dwelt beneath the bed, the people 
in them, and the poultry overhead." 

The drainage and the mode of Hving throughout the 
island were wretched in comparison with England, Wales, 
and Scotland, yet the general death-rate in Ireland for the 
twenty-five years under consideration was far below that of 
Great Britain. The proportion of infant to total mortality 
was equally low, and zymotic disease was not much more 
than one-half in proportion to what it was in England, 
Wales, and Scotland. Yet the so-called causes of such 
disease prevailed in Ireland far more than in those countries. 
These low death-rates led to the belief that registration in 
Ireland was imperfect, though there was no reason why the 
law should be violated here any more than in England and 
Wales. The percentage of infant and zymotic mortality, 

* Sanitary Journal, Glasgow, 1SS7-8S. 



424 VAGARIES OF SANITARY SCIENCE. 

however, could not be affected by imperfect registra- 
tion. 

The registrars of the different districts frequently report 
to the registrar-general the bad sanitary condition of the 
towns. In 1869 nothing could be worse than the sanitary 
condition of Goleen. But Goleen that year had a death- 
rate of 12.2 per thousand. In 1874 the registrar of Emly 
wrote that " it is not an uncommon thing to see four or five 
human beings, two pigs, a goat, a cow, and a score of fowl, 
with perhaps a donkey, inhabiting in common one small 
room. That year Emly's death-rate was fourteen per thou- 
sand. Again, in Banbridge there was a shocking sanitary 
condition : of seventeen pumps not one yielded pure water, 
and four were actually dangerous ; all refuse was poured 
into the streets, and when it rained it oozed into the wells, 
so that, the registrar says, " in plain language, people are 
drinking a solution of human excrement." The death-rate 
of Banbridge that year was fifteen per thousand. The 
registrar-general says (1874) that the reports show that in 
the majority of districts there is " utter neglect of sewerage, 
cleansing, or any other method which might tend to the 
healthfulness of the localities." A long list of places is 
given where the sanitary condition is abominable. Port- 
glenore, Hillsborough, Fintona, Ballymate, Kilmedan, and 
Bangor are in a loathsome state. The death-rate of these 
places is recorded as fifteen, seventeen, fourteen, nineteen, 
seventeen, and fifteen per thousand. In Mulltown Malbray 
the wells are defiled with sewage. The death-rate here is 
1 1.3 per thousand. In Dromore there were "abominable 
cesspools and collections of filth about the doors and under 
the windows of the houses ;" here were " pestilential vats, 
the stench from which was truly unbearable." The death- 
rate for Dromore that year was 14.8 per thousand. In 1872, 
Castleneagh was reported in horrible sanitary condition. Its 
death-rate was 11.5 per thousand. Indeed, it appears that 



THE VITAL STATISTICS, 42^ 

about in proportion to the filth of these localities, which the 
registrars seem to gloat over in their descriptions, do we 
find the good health of the people not only in the general 
death-rate, but in those sensitive and pretended unerring 
tests of sanitary condition, — namely, proportion of zymotic 
and infant mortality to that of total mortality. If we con- 
sider typhoid fever, which the sanitarians tell us is the disease 
of all others amenable to preventive measures, we find in 
the reports of the Irish registrar-general that for twenty-five 
years it was two or three times more prevalent in Dublin, 
which had the benefit of sanitary law and measures, than it 
was in other parts of the island where the sanitary condition 
received little or no attention. Dr. Grimshaw * wrote, 
" When it is remembered that enteric fever is generally con- 
sidered by sanitarians to be dependent upon bad drainage or 
impure water-supply, it is difficult to account for the sudden 
increase of that form of fever in Dublin, as we know that 
the water-supply is nearly perfect, and that the drainage has 
been steadily, though slowly, improving." A writer in the 
British Medical Journal of November, 1 891, says, "The 
steady increase of enteric fever for about a quarter of a 
century has been well known and often commented on by 
Dublin sanitarians ;" yet in Ireland, just where the drainage 
was most imperfect and the water-supply most impure, do 
we find typhoid fever at its minimum, and its maximum is 
shown to be where the water-supply was purest and the 
drainage the best. 

Registration of vital statistics was begun in Scotland in 
1855. The registrar-general says, in his first report, " No 
one can have visited the rural districts of Scotland without 
being struck with the filthy state in which most of the houses 
of the peasantry are kept : damp earthen floors, low roofs 
covered with thatch, a fixed window of small size which 



* British Medical Journal, November, 1S71 



426 VAGARIES OF SANITARY SCIENCE. 

gives little light and no ventilation, no chimney for the smoke 
from the fire to escape, a pool before the door into which 
every fluid refuse is thrown, and which exhales a choking 
putrid exhalation during all the warmer months of the year, 
a pigsty or dunghill close to the wall of the house behind." 
Yet these rural communities gave a death-rate, year after 
year for thirty years, of about seventeen per thousand for 
the mainland, and about sixteen per thousand for the insular 
districts, against about twenty-five per thousand for the 
cities where sanitary improvements were being carried out. 
Infant mortality was about twice as great in the cities as in 
the country, and zymotic diseases were much more fatal in 
towns than in the country districts, which had no sanitary 
supervision. What was still more remarkable, after sanitary 
laws were well in operation and sanitary measures well estab- 
lished, zymotic diseases suddenly rose. The registrar-general, 
in the tenth report, says that the mortality from this class of 
diseases, which had been low and uniform for eight years, 
took a sudden rise in 1863-64. 

The average annual death-rate for Scotland for the 



Five years 


ending 


1859- 


was 20.4. 






1864 


" 22.1. 






1869 


" 21.9. 






1874 


" 22.4. 






1879 


" 21. I. 






1884 


" 19.6. 






1889 


" 18.6. 



The sharp rise in death-rate in Scotland after 1859 was 
maintained for nearly twenty-five years, yet during those 
years the sanitary excitement was at its height, sanitary laws 
were passed, and sanitary measures were carried out. The 
death-rate fell from 23.2 per thousand in 1875 to 20.8 in 1876. 
This year there was a sudden decline of zymotic deaths, but 
it could not be accounted for any more than the sudden 
increase thirteen years before in 1863. Meantime, the birth- 



THE VITAL STATISTICS. 42/ 

rate declined from 35.1 per thousand in 1875 to 30.8 per 
thousand in 1889. 

The death-rate in Sweden was steadily declining, as it had 
been for the previous century, during the forty years that it 
was stationary in Great Britain. In 1 840 it was twenty-three 
per thousand; for the five years 1851-54 it was 21.3; for 
the twenty years 1852-72 it averaged 20.4 ; and for the five 
years 1873-77 it was nineteen per thousand. No sanitary 
laws were passed in Sweden previous to 1876.* Turning to 
France, we also find a reduction in the death-rate during the 
very years it was stationary in England. It was twenty-five 
per thousand between 1817-36. France had two disastrous 
years of war, 1870-71, when the death-rate ran up to twenty- 
eight and thirty-four per thousand ; but, including these, her 
death-rate decreased to 23.6 for an average of twenty years, 
1861-80. France was entirely destitute of sanitary codes. 
The London Lancet in 1891 informs us that there is a health 
law pending in France, and it congratulates the French that 
its adoption will remove the reproach that, with the excep- 
tion of Turkey and Spain, France is behind all other Euro- 
pean countries in sanitary legislation. The inflexible law of 
Sanitary Science, that two and two make five, is now so 
firmly established in our minds, that a survey of France's 
vital statistics occasions no surprise. Bearing in mind this 
law, we find, just what we ought to expect, that France, 
including the two disastrous years of war, had for twenty 
years a death-rate of from two to seven per thousand below 
that of any other Continental European country except 
Norway, Sweden, and Denmark (three almost entirely rural 
countries), and of Belgium, and excluding the two years of 
war, France's death-rate was lower than that of Belgium. 
In 1863 and 1864 the death-rate was lower in France than 
it was in England. For the twenty years 1861-80 the death- 

* Palmberg, " Hygiene." 



428 VAGARIES OF SANITARY SCIENCE. 

rate of Norway, Sweden, Denmark, Austria, Prussia, Hol- 
land, Belgium, Italy, and France was 16.9, 19.2, 19.7, 31^ 
26.8, 24.7, 22.8, 30, 23.6. Still having no sanitary law, the 
death-rate of France continued to fall, so that the average 
for nine years, 1881-89, was 21.9, that for 1889 being 20.5 
per thousand. 

The English sanitarians checked all criticism by offering 
as an explanation for the steady maintenance of the death- 
rate of forty years before, that the greater aggregation of 
people in English towns — density of population being an 
important law of mortality — defeated the good effect of 
sanitary measures. Nobody seems to have questioned this 
explanation, or to have publicly noticed that the same urban 
aggregation was going on in those countries where the death- 
rate was declining. Neither did any one twit the sanitarians 
with the answer that they had all along promised that sani- 
tary law would overcome the ill results arising from density 
of population. They had said over and over again that a 
closely-populated region, with proper sanitary supervision, 
was much more healthy than a sparsely-settled locality 
without sanitary care. Besides, especially in England, the 
very cities which had increased had taken on a suburban 
character. Men and women who were employed in the 
heart of towns were making homes for themselves and their 
families in the suburbs. The day census of the city of Lon- 
don in 1866 showed that one hundred and seventy thousand 
one hundred and thirty-three people were employed in its 
limits; in 1881 this number had increased to two hundred 
and sixty-one thousand and sixty-one ; while the night popu- 
lation, which in 1871 was seventy-four thousand eight hun- 
dred and forty-seven, in 1881 was only fifty thousand five 
hundred and twenty. The rate of increase in suburban dis- 
tricts for twenty years, 1861-80, was one hundred and 
twenty-seven ; while that of the city was only thirty-six per 
cent. 



THE VITAL STATISTICS. 429 

There was one reply which the sanitarians made that could 
not be disputed, and which, as a last resort, they never failed 
to use, — namely, that the death-rate was less than it would 
have been if they had not been elevated to power. 

In 1 876 the death-rate in England and Wales was twenty- 
one per thousand, having been 22.8 in 1875, and having 
averaged 22.3 for thirty-six years ; it had not been so low 
before for twenty years. It sank to 20.4 per thousand in 
I ^yy. The registrar-general says, " The meteorological con- 
ditions were more favorable to health." 

This was a period of general health throughout Europe. 
The death-rate that year fell abruptly in Denmark, Sweden, 
Austria, Prussia, France, and Italy, to 18.7, 18.5, 31, 25.5, 
21.7, 28.1, against an average for twenty years, 1853-72, of 
20.3, 20.4, 31.9, 27.2, 23.6, 30.2. The death-rate suddenly 
rose in England and Wales in 1878 to 21.7 per thousand. 
From this time forward it continued to decrease, so that for 
the ten years ending 1890 it was 19.2 per thousand for those 
countries. It was natural to inquire if there were any known 
causes for this decline in death-rate. The sanitarians were 
now just as ready with their reasons for its decline as they 
were before with reasons for its continuance at its steady 
figure for the previous forty years. The same aggregation 
of population was going on, but the sanitarians said it was 
plain to every one why the death-rate decreased, — it was 
owing to sanitary law. The health act of 1875 was passed, 
and sanitary effrontery was now equal to the task of asking 
us to believe that taking the yeas and nays on a health bill 
in the British House of Commons not only caused an im- 
mediate fall in the death-rate in Great Britain of two per 
thousand, but had such a far-reaching effect as to cause 
almost precisely the same in France, Italy, Austria, Prussia, 
Denmark, and Sweden. There was an almost steady de- 
crease of deaths in the Continental countries from 1875 to 
1890. 



430 VAGARIES OF SANITARY SCIENCE, 

Death-rates for five Death-rates for ^ve 
years, 1871-75. years, 1886-90. 

England and Wales 21.9 18.8 

Scotland 20.7 18.8 

Ireland 17. 7 17.9 

Denmark 19.5 18.7 

Norway 17.5 16.8 

Sweden 18.2 16.2 

Austria . 32.7 28.8 

Switzerland 23.5 20.4 

Prussia 27.7 23.9 

Netherlands 25.6 20.7 

Belgium 23.3 20.0 

France 24.9 21.9 

Italy 30.3 27.2 

Though internal improvements were going on in these 
countries, hardly any of them had the benefit of so-called 
sanitary measures. France was entirely destitute of sanitary 
law ; none of them had suffered sanitary persecution ; and 
yet all, except Ireland, experienced about the same reduc- 
tion in death-rate as England and Wales. Italy's death-rate 
had fallen off, proportionately, about the same as that of 
England; her "sanitary condition" is described in the Lon- 
don Lancet, December, 1891. Of the eight thousand two 
hundred and fifty-eight communes in that country, six thou- 
sand four hundred and four had no drains in the main streets, 
even for rain-water ; refuse of all kinds is flung out to await 
the convenience of the scavenger. , Only ninety-seven com- 
munes had a regular sewer system. In three thousand 
six hundred and thirty-six communes, containing eleven 
millions of people, the vast preponderance of the houses 
had no latrines. English water-closets are confined, even 
in the chief towns, to the hotels or abodes of English and 
American residents. In twelve hundred and eighty-six com- 
munes, latrines are unknown. Communes representing nine 
million inhabitants had drinking-water that was distinctly 
tainted and unwholesome. Yet, with these detestable con- 



THE VITAL STATISTICS, 43 1 

ditions, Italy participated in the general decline in death- 
rate. 

Since 1881, when the causes of death were first registered 
in Italy, the vital statistics show a steady decrease in all in- 
fectious diseases in that country except diarrhoea and dys- 
entery. Instead of increasing, as in England, diphtheria, 
which in two hundred and eighty-four principal towns of 
seven and a half million people caused 11.2 deaths per ten 
thousand living in 1881, diminished almost steadily, so that 
only 4.7 deaths are recorded for the same disease in 1890, 
and only 4.1 for the whole country. Typhoid fever rose 
slightly in the same places until it reached 10.5 deaths per 
ten thousand in 1885, when it began to fall steadily, so that 
it only caused 6.y deaths for the same number of people in 
1890. In 1863 Dr. Hughes Bennet could hardly find a 
trace of typhoid fever in the hospitals at Naples. In 188 1 
it caused 9.4 deaths per ten thousand living in that city. 
This number dropped suddenly the next year to six, and 
continued steadily to fall to four in 1887, to three in 1888, 
and to 2.5 per ten thousand in 1890. Yet Naples had no 
benefit from " sanitary measures" until after 1886. Typhoid 
fever fell in Catania from eighteen per ten thousand in 1881 
to seventeen in 1884, and to six in 1890. It fell in about 
the same proportion at Palermo, and all over the country ; 
in those places where improvements were going on as 
where none were undertaken ; showing clearly the spon- 
taneous rise and fall of this disease in Italy without regard 
to " sanitary measures." The vile condition of Rome is 
familiar to all travellers ; open sewers and untrapped drains 
are here the rule; yet typhoid fever in that city is no more 
fatal than it is in carefully-sewered and rigidly-policed 
Washington. Malarial fevers, which caused in two hun- 
dred and eighty-four principal towns, containing seven and 
a half million people, 6.2 deaths per ten thousand in iSSi, 
fell to 3.2 for the same number in 1890. The mortality 



432 VAGARIES OF SANITARY SCIENCE. 

from puerperal fever was about the same in 1881 in Italy as 
it is now in England. It had fallen, however, more than 
thirty per cent, in 1890. There is also a marked decline in 
the two hundred and eighty-four towns in tuberculosis from 
31.9 in 1 88 1 to 27.5 per ten thousand in 1890. Measles, 
which shows no decline in England, has diminished one- 
half in Italy during the last ten years, and scarlet fever has 
fallen off in about the same proportion, so that in spite of 
the disgraceful condition which pervades all parts of Italy, 
and which is not at all overdrawn in the Lancefs account, 
as all travellers will attest, infectious diseases seem to be 
steadily falling off to a most striking degree, and that, too, 
over the entire country. 

The fact is, that what is called the sanitary condition 
of England and Wales did not differ in 1876 and 1877, 
when the death-rate was 21 and 20.4, from what it was 
in 1875 and 1878, when it was 22.8 and 21.7. There was 
no repeal of the health act in 1878 which could cause the 
sudden rise from 20.4 to 21.7 per thousand, which was 
almost exactly what it was forty years before ; neither was 
any addition made to this act which caused it to fall two 
years later to 20.5 per thousand. 

What was the health law of 1875 ? It was the consoli- 
dation of previous acts with the addition of some new pro- 
visions ; but it is simply ridiculous to allege that any of its 
clauses, old or new, had any bearing on public or private 
health. It prescribed the cleaning of roadways and pave- 
ments ; the removal of snow ; cleaning earth-closets and 
cesspools ; it fixed the number of lodgers, and provided for 
the separation of the sexes in lodging-houses ; it arranged 
for the laying out of streets and erection of buildings ; the 
regulation of markets ; the inspection of slaughter-houses ; 
the care of cemeteries, forbidding the pasturing in them of 
cattle; it prescribed how the cabmen should feed their 
horses in the street ; that cab-lamps should be lighted at 



THE VITAL STATISTICS. 433 

night; it fixed the rate of fares; supervised the public 
baths, and set forth the limits for the approach of the two 
sexes in them ; forbade the use of indecent language or the 
indecent exposure of the person ; it ordered how people 
should conduct themselves in pleasure-grounds, and regu- 
lated the hiring of asses and mules in the parks ; it con- 
trolled the carrying on of soap-boiling, tanning, glue-making, 
etc. ; in fact, it took cognizance of pretty nearly everything 
that had been proved for centuries to have no relation to 
health or longevity. 

The health act of Ireland was passed in 1878. It was 
almost precisely Hke that for England and Wales. The 
death-rate of Ireland, which previous to that year had no 
sanitary law, for the preceding fifteen years was 17.1 
per thousand. And now, to sharpen the irony, her death- 
rate for the next twelve years rose to 18.2 per thousand. 
The average death-rate of England and Wales for twenty 
years, 1861-80, while they were enjoying the benefit of most 
despotic health laws, was 21.9, and for the ten years ending 
1890 it was 19.2 per thousand. 

The percentage of deaths from zymotic diseases in Ire- 
land, 1870-79, was 1 1.7; that for the previous decade was 
eighteen, showing clearly that decline of contagious disease 
was not dependent on sanitary law or sanitary measures. 
For the same period the percentage of zymotic to total 
mortality in England averaged from 18 to 21 per thousand. 

The futility of sanitary law or sanitary measures in con- 
trolling those diseases which are registered as zymotic is 
clearly shown in the vital statistics of England and Wales. 
These diseases caused 4.52, 4.25, 4.21, and 4.06 deaths 
per thousand for the four years, 1838-39 and 1841-42, 
which preceded the sanitary eruption. Twenty years later, 
1859, these diseases caused 5.46 per thousand; in 1862, 5.88; 
and in 1863, twenty-five years after the outbreak of sanitary 
reform and the beginning of sanitary measures, zymotic 
T cc 37 



434 VAGARIES OF SANITARY SCIENCE, 

deaths, which these measures were to prevent altogether 
had risen from 4.25 to 5.88 per thousand living. As late as 
1 87 1 zymotic disease caused 5.44 deaths per thousand living. 
In 1874 zymotic deaths were 4.76 per thousand, and 4.47 in 
1875. In 1876 this mortality fell to four per thousand, to 
rise again in 1878 and 1880 to 4.24 and 4.13, almost exactly 
what it was forty-two years before. It continued to fall 
from this on. Small-pox was nearly blotted out, scarlet 
fever showed a marked falling off, and diarrhoeal diseases, 
though widely fluctuating, as will be seen, had declined. 
For the decades — 

1841-50 zymotic disease caused 5.20 deaths per thousand living. 
1851-60 « « 5.05 « « 

1861-70 " " 5.20 « « 

1871-80 «« « 4.23 « « 

For the next ten years zymotic deaths fell off to an aver- 
age of about 2.60 per thousand living. But for forty years, 
when the sanitary excitement was the fiercest and sanitary 
laws the most severe in England and Wales, there was no 
decline in zymotic disease, while in Ireland, which had no 
sanitary law, the percentage of zymotic to total mortality, 
which was twenty-three for the decade 1851-60, fell to 
eighteen for the decade 186 1-70, and to less than twelve for 
the decade 1871-80. Very early in this century zymotic 
diseases had begun to decline in Sweden. The deaths from 
the class " putrid fevers" fell off in that country from 7284, 
the average for five years, 1806-10, to an average of 205 
for the five years 1826-30. Between 181 1 and 181 5 there 
was a sudden fall from the first number to 3668. For the 
five years 1806-10 there was an average of 1728 deaths 
from small-pox in Sweden ; this number fell to an average 
of 327 deaths for the five years 1826-30. 

Turning to individual diseases which are classed zymotic, 
we find that their presence or absence has no relation to 



THE VITAL STATISTICS. 435 

sanitary measures. In 1838 small-pox in England and 
Wales destroyed 1064 people per 1,000,000 living; the 
number of deaths from that disease fell to 168 per 1,000,000 
in 1842. In 1852 the number of small-pox deaths rose to 
401, falling in 1861 to 64 and rising again to 10 12 and 821 
per 1,000,000 living in 187 1 and 1872, falling to 21 in 1879, 
and rising to 119 and 103 in 1881 and 1885, falling to 
10 and I per 1,000,000 living in 1886 and 1888, The most 
thoughtless sanitarian will not claim that these fluctuations 
of mortality bore any relation to the " sanitary condition" 
of England and Wales ; that these countries were very dirty 
in 1838, when 1064 per 1,000,000 died, or that they were 
very clean in 1842, when only 168 per 1,000,000 were de- 
stroyed by small-pox, and that the deaths varied for the 
next fifty years in proportion as the filth was greater or less 
in amount. Neither did these fluctuations in mortaHty rep- 
resent the vaccination of the people ; the disease always came 
in waves ; the unknown influence which controlled all epi- 
demics guided this disease. In 1839 the registrar-general 
says five die weekly in London of small-pox when it is not 
epidemic ; but " the question is not why these five die weekly, 
but why they become 10, 15, 31, 58, 88, weekly, and then 
fall progressively back the same measured steps." For the 
twenty years 1760-79 the average number of deaths from 
small-pox in London was 2333 ; for the next twenty years 
the number fell to an average of 1740. Dr. Farr says that 
this disease was declining before vaccination was discovered, 
" indicating, together with the diminution of fever, the general 
improvement of health then taking place." Dr. Farr says 
that the reduction in mortality from this disease is " the re- 
sult, at least in part, of the vaccination act." But he notices 
with surprise that the deaths in France from small-pox 
were in 1842 only 91 per 1,000,000 living, and that 
for the years 1841, 1842, and 1843 the deaths in Austria 
from that disease were 4619, 5 189, and 441 1 out of a popu- 



436 VAGARIES OF SANITARY SCIENCE, 

lation of 22,000,000, while the deaths in England, where 
vaccination was discovered and which had a vaccination 
act, in 1838 and 1840 were 16,268 and 10,434 out of a popu- 
lation of less than 16,000,000. During the last great 
sweep which small-pox made over Europe,* the faith in 
vaccination to prevent its epidemical visits was terribly- 
shaken. In Bavaria, of 30,742 cases, 29,429 had been vac- 
cinated. Prussia was the best vaccinated country in Europe, 
and yet the mortality from small-pox was higher in that 
country in 1871 than in any other northern European State, 
and the death-rate in the German army, where revaccina- 
tion is rigidly practised, was sixty per cent, greater than in 
the civil population of the same age, and the Bavarian 
Contingent in 1870-71, every one of which had been re- 
vaccinated, had five times more deaths from small-pox than 
the civil population of the same age. In 1870, at Cologne, 
the first unvaccinated person taken was the one hundred 
and seventy-fourth case in the town, and in Bonn and 
Liegnitz the unvaccinated ones seized were the fifty-second 
and the two hundred and twenty-fifth cases. Of 6533 
admissions into Eastern Metropolitan Hospital, between 
1 87 1 and 1878, 5076 had been vaccinated. In 1871 and 
1872, 14,808 patients were treated in hospitals in England 
for small-pox; of these, 11,174 had been vaccinated. Dr. 
Farr said, " Vaccination, therefore, does not afford entire 
immunity against attack or even death by small-pox," and 
about the only comfort that was derived during this furious 
epidemic from vaccination was, that it rendered the disease 
much less fatal. 

Measles shows nearly the same fluctuations as small-pox; 
it caused 426, 705, 266, and 594 deaths per 1,000,000 in 
1838, 1839, 1853, and 1887. For the ten years previous to 
1875 measles caused an average of 401 deaths per 1,000,000 

* 1870-72. 



THE VITAL STATISTICS. 43/ 

living, while for the ten years ending 1890 the average was 
440 per 1,000,000. Scarlet fever caused 380, 1256, 747, 
1030, 652, 12 1 2, 451, 1478, 546, 1446, 515, and 1050 deaths 
per 1,000,000 living in 1838, 1840, 1849, i^S^, 1857, 1858, 
1861, 1863, 1866, 1870, 1872, and 1874, gradually faUing to 
691, 694, 675, 472, 215, and 231 per 1,000,000 living in 
1876, 1879, 1880, 1883, 1886, and 1889. 

It cannot be possible that these widely-vacillating figures 
represent the "sanitary condition" of England; that the 
country was in fairly good " sanitary condition" in 1838, 
when scarlet-fever deaths were 380, but that in 1840 it had 
undergone a frightful change for the worse, so that 1256 
per 1,000,000 living died of this disease, or that it still con- 
tinued to grow worse, until in 1870 the sanitary condition 
was so bad as to cause 1446 deaths per 1,000,000 from 
scarlet fever, and that the sanitary condition suddenly grew 
better in 1872, when only 515 died per 1,000,000, again 
growing so much worse in 1874 that it destroyed 1050 
people per 1,000,000 living, or that the country was only 
half as dirty in 1886, when it caused 215 deaths, as it was 
in 1883, when it caused 472 deaths per 1,000,000. 

The folly of ascribing the rise and fall of mortality from 
these diseases to the absence and presence of "sanitary 
measures" was, after a few years, apparent to the most un- 
reflecting sanitarian, and the theory that these were caused 
by filth was abandoned. The reformers, however, were all 
the more obstinate in maintaining that diarrhceal diseases, 
typhoid fever, and diphtheria were the offspring of filth. 
Diarrhceal diseases caused 203 deaths per 1,000,000 living 
in 1838; this number was not higher than 260 for the next 
four years, when it rose to 372, leaping in 1848 to 780, and 
in 1852 to 1 1 17 per 1,000,000 living. It did not fall again 
to much below 600 per 1,000,000 until 1885, — reaching in 
eleven of the years between 1852 and 1885 to 1 000 and 
over, — when the number dropped suddenly to 487 deaths 

37* 



438 VAGARIES OF SANITARY SCIENCE. 

per 1,000,000. In 1884 diarrhceal diseases caused 971 
deaths; in 1886 and 1887 they caused ZZZ and 717 deaths 
per 1,000,000. The deaths from diarrhceal diseases in 1889 
were 635 per 1,000,000, more than three times as many as 
they were fifty-one years before, in 1838. Yet no disease 
has been more persistently held up to us as a filth-disease 
by the sanitarians. They could not fail to see, however, 
that it had doubled, quadrupled, sextupled even, in spite of, 
and about in proportion as, sanitary measures were adopted. 
Some explanation was required. The ingenious sanitarian 
was equal to the occasion. He said diarrhoea depended on 
a certain temperature of the filthy soil, which quickened 
the germ that lay therein into activity ; he did not say how 
this ground did not happen to get heated in England until 
about 1848, neither did he claim that the germ had ever 
been found in the soil ; in fact, it had not even been sought 
for. Nobody disputed the theory. Although the proof of 
its absurdity lay right before the eyes of the American 
sanitarian, in the comparative statistics of Philadelphia with 
New York, and New Orleans with Boston, no parrot ever 
responded with greater fidelity to his instructor than did 
our native sanitarian to his Anglican tutor in this instance ; 
without any examination he accepted the theory, and not 
only actually published it in this country as one of the 
" settled principles of Sanitary Science," but demanded that 
the law-making power should shape its sanitary legislation 
to correspond with this theory. Sanitary measures had 
been established for nearly twenty years before diphtheria 
was recorded at all in the vital statistics of England. In 
1855 it caused 20 deaths per 1,000,000 living. Four years 
later it caused 517 deaths per 1,000,000. The number fell 
to 93 in 1872, rising again steadily, as sanitary law became 
more stringent, to 189 per 1,000,000 in 1889. The death- 
rate in London from diphtheria for ten years, 1881-90, was 
259 per 1,000,000 living against 122 deaths in the preceding 



THE VITAL STATISTICS. 439 

ten years.* Typhoid fever was hardly known in England 
before the adoption of sanitary measures ; it was not sepa- 
rated in the registrar-general's report from typhus and con- 
tinued fevers until 1869, when it caused 390 deaths per 
1,000,000. 

This increase of typhoid fever in England during the 
progress of so-called sanitary measures is exactly what is 
taking place now in China and in India. Dr. Jamieson, in 
his studies of enteric fever in Shanghai, f says its existence 
was doubted in China twenty-five years ago, but that look- 
ing back for a quarter of a century it has steadily grown in 
importance as sanitary improvements have been going on. 
Malarial fevers have declined, and he says it may be asked 
whether subsoil drainage which removes malarial fevers 
" may not contribute to the increase of enteric disorders." 
The only cause of typhoid fever in China that he mentions is 
the predisposing one of age. 

The number of typhoid-fever deaths in England remained 
nearly stationary from 1869 until i%'j6-'j^, when it fell to 
309 and 306 per 1,000,000 living. It dropped sharply off to 
231 in 1879, and continued to fall with slight intermission 
until 1889, when it caused 173 deaths per 1,000,000. In 1890 
typhoid fever caused 179 deaths per 1,000,000 living in 
England and Wales. The number of deaths in three dis- 
tricts was as low as 31, 45, 64, and as high as 250, 367, 516 
per 1,000,000 Hving in three other districts. Do these 
figures represent the filth of these respective districts, or 
do they represent the " unknown quantity" which the Mas- 
sachusetts Board of Health say was necessary to produce the 
fever in that State ? 

This disease, which was unknown before the era of sani- 
tary reform, and which the sanitarians say is wholly under 

* Louis Parkes, Hygiene, April, 1S92, 
I China Imperial Maritime Customs, 1S91. 



440 VAGARIES OF SANITARY SCIENCE. 

our control, continues to cause more than five thousand 
deaths annually in England and Wales, 

Mr. David Rennet * made an important study of typhoid 
fever in Scotland for twenty-five years, 1865-89. His in- 
quiries extended over the whole mainland country, embracing 
a population of more than three million. In eight principal 
towns, except one, there was a marked fall in the death-rate 
from typhoid fever. In Paisley there was an increase of 
three per cent. But this decline in towns in typhoid fever is 
far from uniform, although all of them have improved water- 
supplies and efficient sewerage. Edinburgh and Leith have 
water and drainage system in common, yet their typhoid 
death-curves have no resemblance, as one shows a constant 
decline, while the other shows a steady decline and great 
variation. This decline in towns varies from sixty-nine per 
cent, for Aberdeen to twenty-two per cent, for Perth ; in none 
of the cities does the fall bear any relation to water-supplies 
and drainage. In some cities there was, for a few years after 
the introduction of improved water and sewerage, a constant 
rise in the typhoid fever death-rate. Besides, he says the last 
few years, which is " precisely the period which has been 
marked by the greatest zeal for sanitary matters in the cities," 
the typhoid death-rate has remained stationary. The decline 
of typhoid fever in the rural districts of Scotland corresponds 
for five-year periods almost exactly with the decline in cities. 





1865-69. 


1870-74. 


1875-79- 


1880-84. 


1885-89. 


Rural districts . . 


. . 45 


36 


2,^ 


27 


19 


Cities 


. . 37 


36 


34 


26 


19 



per one hundred thousand living. No reason can be given 
for this decline in the rural districts, which is greater in pro- 
portion than in the cities. The sanitary work has been con- 
fined entirely to the latter. With rare exceptions, no attempt 

* Sanitaf-y Journal, Glasgow, January 19, 1893. 



THE VITAL STATISTICS, 44 1 

has been made to get purer water-supplies in the country, 
and a large majority of the people live in undrained houses. 
*• The old wells in use thirty years ago are in use now, and 
we know they are far from good. The methods of excreta 
removal are the same as thirty years ago." Mr. Rennet says, 
" We cannot, then, well account for the fall in the typhoid 
death-rate by the sanitary improvements of the last twenty- 
five years." He thinks it may be accounted for, in that the 
people everywhere are better fed and clothed ; they have less 
work and more wages ; there is a higher grade of intelligence 
and education among them, and they have a better knowl- 
edge of the benefits of cleanliness. He illustrates the differ- 
ence in death-rate between the poor and the rich by Aber- 
deen, which has two parishes,— one inhabited by the poor, 
the other by the rich. The water-supply and drainage are 
alike ; but the poorer part shows an average for ten years of 
one hundred and five cases of typhoid fever per hundred 
thousand, while the well-to-do parish has sixty-three cases 
per hundred thousand from typhoid fever. 

Typhus-fever deaths declined in England and Wales from 
193 in 1869 to 36 in 1878, and from that to 5 per 1,000,000 
living in 1889. The deaths from continued fever were 239 
in 1869, 71 in 1878, and only 14 per 1,000,000 in 1889. It 
was never claimed that these fevers depended on filth or 
want of drainage ; their disappearance and their appearance 
were equally mysterious. The returns of the registrar-gen- 
eral of England show that the mortality from three of the 
most important zymotic diseases steadily mounted higher for 
from twenty to forty years as sanitary laws were made more 
stringent and sanitary measures were made more thorough, 
and nothing seems plainer from the study of these reports 
than that the rise, progress, and decline of these, along with 
others of the zymotic class, bore no relation to such laws 
and measures. That there has been in the main a falling off 
of infectious diseases in Great Britain is not denied ; but this 



443 VAGARIES OF SANITARY SCIENCE. 

decline has been no less pronounced everywhere, so far as 
we can gain information, alike in places which have had 
sanitary laws and measures as those which have not. Ire- 
land is a most notable instance. Indeed, the decline in con- 
tagious diseases had been going on in Great Britain for a 
century until about 1840, when they appear to have received 
a new stimulus and to have increased for more than thirty 
years ; and during that time diseases reappeared which had 
been absent so long that they had been almost forgotten. 
For the thirty years 1728-57, fever caused 148 of every 
thousand deaths; for the ten years 1771-80, it caused 124; 
for the ten years 1 801-10, 89; and for the five years 1831- 
35, it caused 34 of every thousand deaths.* Fever, plague, 
and dysentery caused four-tenths of the fatal diseases in the 
sixteenth century. But while the sanitary excitement was 
the fiercest, the fever death-rate was rising; it fell from 10.4 1 
deaths per ten thousand living in 1852, to 6.63 in the follow- 
ing year, when it again rose to 9.30, 9.77, 11.9, and 10.05 
deaths per ten thousand in i860, 1864, 1865, and 1866. 

We have seen on a previous page how contagious diseases 
had declined in Sweden during the first forty years of this 
century. 

Although the " sanitary condition" of London must have 
been worse than the country at large, the zymotic death- 
rate in that city in 1841-42 was less, being only 3.59 and 
3.39 per thousand. In spite of fierce sanitary laws and 
thorough sanitary measures, this death-rate was not so low 
again for thirty-one years, when in 1873 it was precisely 
what it was in 1842. The percentage of zymotic to total 
mortality for the decades 1841-50, 1851-60, 1861-70,1871- 
80 was 20.9, 21.3, 21.3, and 17. The general death-rate for 
the five years 1865-69 was exactly what it was for the five 
years 1841-45, — viz., 24.4. 

* London Lancet. 



THE VITAL STATISTICS, 443 

London's death-rate since 1880 has steadily declined to 
an average of 20.5 for ten years, 1881-89, ^"^ 21. 1 for 1890. 
But her sanitary condition was no better in 1885 than it was 
in 1875, before the passage of the health act. Her water- 
supply was even worse ; as we have seen on a previous page, 
it was more and more polluted. In 1887 * the Thames was 
in " a disgraceful state ;" the river was only a " huge sewer ;" 
the " water-supply is fraught with incessant danger," and 
disinfection of the sewage in the river was pronounced a 
" costly sham." The whole " tidal portion is in a horrible 
and dangerous state." The water of one company f " on the 
5th of February, 1891, surpassed in respect of organic im- 
purity any sample of Thames water examined during the 
past twenty-five years;" for "five months of the year 189 1 
the water supplied to London from the Thames was for the 
most part of an inferior quality, and on several occasions for 
days together not fit for dietetic use ; that is to say, not fit to 
drink," and Surgeon Hogg \ writes that " Thames water is 
most shamefully, nay, dangerously, contaminated." Profes- 
sor Ewing, under the heading, "Actual State of London 
Houses," says, " By examination of the best houses in 
London it is no uncommon case for a house to be so com- 
pletely without sewer-connection that all its own sewage 
sinks into the soil under the basement, and seventy-five per 
cent, of the houses inspected have failed to pass the smoke- 
test." A distinguished sanitary writer in this country very 
pertinently asks, " What must be the general condition of 
the houses in London if the best ones are so unsanitary ?" 
Yet her death-rate was decreasing, and notably from that 
class of diseases which these conditions of air, water, and 
soil are said to cause. But a variety of circumstances have 
been present in that city the last twenty years which were 



* London Lancet. f Louis Parkes, Hygiene, 1892. 

% Hygiene, April, 1891. 



444 VAGARIES OF SANITARY SCIENCE, 

calculated to materially diminish its death-rate. Since 1876 
the birth-rate there has decreased from thirty-six to thirty 
per thousand. The marriage-age has increased; all of those 
influences which have been before mentioned as adding to 
the comfort of mankind have been augmented in London ; 
her working-population has steadily sought the suburbs to 
live and sleep, and is becoming more and more semi-rural 
in its surroundings. 

During the last ten years there has been in the City, 
Westminster, the Strand, St. Giles, St. George's-Hanover 
Square, a decrease in population of 25.5, 19.9, 18, 12, 10 per 
cent., while some of the outlying districts have increased in 
the same time from 95 to 133 percent. London, for the 
last twenty years, has been more and more sought for as a 
residence by people in easy circumstances. When these are 
attacked by illness, if a change in climate promises reHef or 
recovery, their departure from town is hastened. London, 
too, is recruited more and more by ambitious and vigorous 
men and women from other portions of the country. 

The death-rate of London in 1891 was 21.1 per thousand. 
The districts of Hampstead, Lewisham, and Wordsworth 
showed a death-rate of 12.4, 15, 15.05, while that of St. 
Giles, the Strand, St. Luke's, and Holborn was 27.6, 29.6, 
30.3, and 30.8 per thousand. The infant mortality, — the 
number of deaths under one year to each one thousand 
births, — for Hampstead, Wordsworth, and Plumstead was 
104, 119, 120, while it was 201, 213, 228 in St. Saviour 
Southwick, Strand, and Holborn, that for the city at large 
being 154. Do these figures indicate that the health act of 
1875 is a dead-letter in the districts with a high death-rate, and 
is rigidly enforced in the others ; or that the health-officers in 
the former are ignorant and careless, while those in the latter 
are educated and vigilant ? Do they not rather show that 
the people in the districts with the low death-rate enjoy ease 
of body and tranquillity of mind ; that they are well fed, 



THE VITAL STATISTICS. 445 

clothed, and sheltered ; that they are sober and industrious ; 
that they are slow to enter the married state ; that, having 
assumed this condition, they are prudent in begetting off- 
spring, and that they do not consider that their duty to 
society ends in the act of copulation, but that they rear 
their children with care and discipline, enlighten their 
minds, and educate their consciences ? On the other hand, 
does not the high death-rate of the other districts represent 
poverty, ignorance, laziness, overwork, and maybe vice and 
intemperance ; that the people there ai'e largely unreflecting 
in taking on the responsibilities of wedlock ; that procrea- 
tion, rather than preservation and education, is the rule? 
As Dr. Letheby despairingly said in 1875, when medical 
officers have the power to place the latter class of human 
beings in the same mental, moral, and physical condition as 
the former, they can correspondingly reduce the death-rate. 
When this change will have been brought about it is safe to 
affirm that health acts which regulate the deodorization of 
ignoble privies, or which forbid cattle to graze in cemeteries, 
or which remove snow from sidewalks, or fix the hiring- 
prices of asses and mules in pubHc grounds, or the location 
of a tanner or a soap-boiler, may, so far as regards the death- 
rate, be dispensed with altogether. 

Liverpool presents an interesting study by which to judge 
of the influence of " sanitary condition" in causing disease 
and of sanitary measures to prevent it. A health act was 
passed for this city in 1846; before 1859 eighty miles of 
sewers had been built, the drainage of dwellings had pro- 
ceeded slowly but steadily ; many thousands had been forcibly 
ejected from the cellars ; urinals had been established ; pub- 
lic baths had been opened ; there had been a gradual aban- 
donment of cesspools ; an increased water-supply ; all privies 
in the interior of houses had been got rid of, and the midden 
entirely prohibited ; yet, with all of these sanitary improve- 
ments which had been going on for twenty years, the death- 



446 VAGARIES OF SANITARY SCIENCE. 

rate was increasing, and the committee which reports on the 
sanitary condition of Liverpool squarely recants the filth 
pathology of disease, for it says, " The town then being in 
respect of drainage and the other matters above enumerated 
in a much better condition than heretofore, and still advancing 
in this kind of sanitary improvement, and yet the death-rate 
ascending higher and higher, it was necessary to look for 
other than the causes belonging to the first group to account 
for this increasing mortality." The committee now say, 
" The proximate causes of the increased death-rate are in- 
temperance, indigence, and overcrowding." One great cause 
of the high mortality in Liverpool, they said, was the " stupe- 
fying of infants with opium by drunken mothers." For the 
five years 1857-61 the death-rate of Liverpool was 29.6; for 
the five years 1862-66 it was 35 per thousand. For the 
ten years ending 1863 there were one hundred and thirty 
thousand deaths in Liverpool ; sixty-five thousand of these 
were under five years. The birth-rate in Liverpool in some 
years had been as high as 42 per thousand for an average of 
five years. Looking at the deaths from fever in Liverpool, 
we find that they had no relation to " sanitary condition." 
Typhus and infantile fevers in 1865, after twenty years of 
energetic sanitary measures and thirty years of sanitary 
excitement, caused 2338 deaths, against an average of 835 
for the previous ten years. There were 1523 deaths from 
the same diseases in 1866 ; this number dropped off suddenly 
the next year to 656, only to rise to 841 in 1868, faUing to 
335 in 1873, and to 248 deaths in 1879, to rise again in 1882 
to nearly 600 deaths, — about as high a mortality as fifteen 
years before, in 1867. Can anything be more silly, or can 
anything be more uncomplimentary to our intelligence and 
common-sense, than for the sanitarians to tell us that these 
figures represent the " sanitary condition" of Liverpool ? Or 
that the diarrhceal deaths represented her "sanitary con- 
dition" any more than fever did, when they were 1 145 in 



THE VITAL STATISTICS, 447 

1866, 796 in 1867, 1 15 1 in 1870, 605 in 1877, 1028 in 1880, 
841 in 1884, 422 in 1885, and 781 in 1886? Liverpool 
shared with the rest of Great Britain and with the Continent 
in the period of health that followed 1875; the average 
death-rate for the ten years 1866-75 was 30.6 ; in 1876 it was 
27.5 ; it rose again in 1878, as it rose elsewhere in England, 
when it reached 29.3 ; but fell from that time almost steadily 
to 1890, when it was 23.3, — averaging for the decade 24, 
but rising in 189 1 to 27 per thousand. But in none of these 
changes in the death-rate of Liverpool is there any relation 
between it and " sanitary condition," except that for more 
than twenty years it rose steadily as the " sanitary measures" 
progressed. 

It is interesting to note that the birth-rate of Liverpool 
has fallen from as high as 42 in some previous years 
(for five years, 1844-48) to 27 per thousand in 1890. If 
the intemperance, indigence, and overcrowding which the 
Health Committee of Liverpool said were the causes of dis- 
ease in that city have not been removed, there are at least 
more than thirty per cent, fewer infants born there to be 
" stupefied with opium by drunken mothers." Hardly any 
city had known such a rapid increase in population as Liver- 
pool ; in 1 83 1 it had two hundred and five thousand, and — 
not estimating the suburbs — in 1 881 it had five hundred and 
fifty- two thousand. The poverty, destitution, and intem- 
perance of large masses of this population were extreme. 
During the last fifteen years, Liverpool, like all English 
cities, owes its increase almost entirely to its suburban popu- 
lation; its municipal population showing in the ten years 
1881-90 a decline of six per cent, while the suburban popu- 
lation increased sixty per cent.; and since 1881 there has. 
been actual decrease even outside the civic boundaries, and 
this decrease was particularly in the slums. The last census 
shows that English cities more and more are taking on a 
suburban character, and the death-rate of the inhabitants is 



44^ VAGARIES OF SANITARY SCIENCE. 

decreasing in proportion, in this respect comparing more 
and more favorably with rural populations. 

The birth-rate throughout Great Britain has now * de- 
creased from 36, in 1876, to 30 per thousand. For more 
than fifty years there has been a steady increase in the age 
of women and men marrying; a steady decrease since 1875 
of the number who marry. For the five years 1871-75 the 
average number was 17; for the five years 1885-89 the 
average number was 14 per thousand ; a steady decrease in 
illegitimacy, being 4.4 per hundred births in 1 890, as against 
6.J fifty years before; a steady increase in intelligence, as 
shown by the number who sign the marriage register with 
their names instead of with their marks. In 1846, 326 males 
and 482 females per thousand, who married, signed the mar- 
riage register with their marks ; in 1890, only J2 men and 
83 women per thousand married failed to write their names 
in the marriage register. During these fifty years there had 
been a steady decline in pauperism. As late as 1849,62 
persons per thousand received poor-law relief in England ; 
24 per thousand were receiving it in 1889. In short, the 
people of Great Britain were steadily advancing in the enjoy- 
ment of material comforts, in intelligence, decency, decorum, 
independence, and self-respect ; they were approaching that 
condition of ease which Dr. Casper said was synonymous 
with vitality, and they were preparing themselves to make 
the most of those favorable but inscrutable changes which 
were going on in the types of disease ; congratulating them- 
selves that perhaps the period of devastating epidemics had 
passed away never to return, when they were reminded of 
the helplessness of the human race by the appearance of 
the blasting scourge of influenza, whicji swept over the globe 
with incredible swiftness, but which seemed to tarry longer 
in Great Britain than elsewhere, and to ravage that country 



[890. 



THE VITAL STATISTICS. 449 

with special virulence, carrying off its people by tens of 
thousands, and increasing her death-rate in 189 1 to 20.2, 
against an average of 19. i per thousand for the previous ten 
years. 

It is probable that these moral and economic influences 
had been in operation long before the period of the begin- 
ning of registration. As early as 1840, Dr. Farr remarks 
that moral restraint is in practical operation in England to 
an extent which will hardly be credited when stated in 
numbers. One-fifth, he says, of the people who attain the 
age of marrying never marry. " The reproductive force 
is repressed by prudence;" and in considering the early 
marriages which prevail in certain parts of Engjland, where 
intelligence is the lowest, and where the competition for 
work and wages is so severe, he asks, " What would be 
the course pointed out by nature? Would it not be to 
defer the present early marriages until they have gained 
some experience in life, and accumulated some of the means 
of living ?" Physiologists and economists would probably 
agree in saying that this increase of the prudence which is 
now in operation would not, except in special cases, hje cal- 
culated to deteriorate the health and intelligence of their 
families, and he asks, " Can any one fear for the conduct and 
fate of this people if they should feel called upon to rear 
fewer children — to marry less early — than during the last 
forty years ?" 

It is a notable fact that during the last ten or fifteen years 
the birth-rate has declined markedly in those Continental 
states in which the death-rate has diminished. 

The more one studies these tables of mortality the more 
one is convinced of the utter ignorance of mankind of any 
laws which prevent the appearance of any disease, or which 
affect its progress or removal. 

Between 185 1 and i860 cancer caused in England 195 
deaths per 1,000,000 Hving. This number has steadily in- 
dd 38* 



450 VAGARIES OF SANITARY SCIENCE. 

creased until i8go, when it caused 6j6 deaths per 1,000,000; 
these were very unequally divided, however, even over this 
small country ; the number of deaths from cancer in Lanca- 
shire in 1890 was 555 ; in Rutlandshire 1036, and in Lon- 
don 786 per 1,000,000. Diseases of the circulatory system, 
which caused, between 1858 and i860, 900 per 1,000,000, 
had steadily risen to 1641 for four years, 1886-89, ^^<^ ^^ 
1757 for 1890, varying widely, however, in different locali- 
ties ; for these diseases caused 2234 deaths in Wiltshire, and 
1445 per 1,000,0000 Hving in Middlesex. 

Phthisis deaths had steadily fallen off from an average of 
2447 for the five years 1866-70 to an average of 1635 per 
1,000,000 living for the five years 1886-90. The health act 
of 1875 was not passed until more than ten years after the 
sharp decline in phthisis began. This decline in deaths 
from phthisis at first took the sanitarians by surprise, for no 
measures had been directed to subdue the disease; they 
very quickly told us, however, that it was the sewers which 
had caused this lessened mortality by relieving the ground 
of its moisture; but we find that phthisis caused 2100 
deaths per 1,000,000 in London in 1890, while only 11 33 
per 1,000,000 died of that disease in Herefordshire. Are 
we to understand by these figures that Herefordshire is 
nearly twice as well sewered as London ? 

Notwithstanding the sewerage had relieved the ground- 
moisture, diseases of the respiratory system increased from 
3394, the average for the five years 1866-70, to 3639 per 
1,000,000 for the five years 1886-90. The mortality from 
rheumatism had largely increased, and diseases of the 
urinary organs had nearly doubled in thirty years. The 
average number of deaths from puerperal fever was 55 per 
1,000,000 for three years, 1858-60; this had increased to 
'j(i per 1,000,000, the average for five years, 1886-90. The 
steady rise in mortality from this disease is startling, in view 
of what we have been led to believe of the efficacy of anti- 



THE VITAL STATISTICS. 45 1 

septics in midwifery. Besides, many times we have been 
told, and most of us really believed, that this disease of all 
others was most amenable to hygienic measures. 

Erysipelas, a disease which, we are told, is specially con- 
trolled by sanitary measures, maintained an average of about 
90 per 1,000,000 from 1858 to 1885, when it suddenly 
dropped, without any apparent cause, to an average of 54 
per 1,000,000 living. For three years, 1858-60, the number 
of deaths from old age was 1422 per 1,000,000; the average 
for five years, 1886-90, was 960 per 1,000,000. 

In looking over the vital statistics of our own country, we 
find no relation between disease, and especially zymotic 
disease, and " sanitary condition." Dr. Billings, in his elab- 
orate work on the vital statistics of the United States, 1880, 
says, pointedly, of diphtheria, which has probably given 
rise to more sanitary persecution in our country than any 
other disease, that " the disease cannot be due to any pecu- 
liarity of climate, of geological formation, of topography, or 
of methods of filth-disposal." Typhoid fever in 1880 was 
most prevalent in the Appalachian regions of North Caro- 
lina, Georgia, Alabama, and Tennessee, and in Central Ohio, 
all Indiana, the southern part of Missouri, eastern part of 
Texas, the western half of Kansas, and in Oregon. It was 
comparatively low in New England, Central Pennsylvania, 
the Mississippi Valley, and Gulf coast. Does any intelligent 
person believe that the privies were more leaky, or that 
there was greater carelessness in rinsing milk-cans, or that 
turtles tumbled oftener into the wells, or that decaying 
twigs and stumps were more plentiful in the water-courses 
in the first than in the second group of districts ? Do w^e 
know why this disease chose those regions for its ravages 
any more than we know why cancer, which the same year 
caused 18.34 ^^^ o^ every 1000 deaths for the whole 
country, should cause 33.23 deaths in the Northeastern 
hills, while in the South Atlantic coast, in Charleston, it 



452 VAGARIES OF SANITARY SCIENCE. 

should cause only 5.70 of every 1000 deaths ? It is nothing 
to say that cancer is twice as prevalent in the white as in 
the colored race ; this gives no explanation why the white 
race in our country is two or three times more likely to 
have cancer in one locality than in another five hundred 
miles away. 

In 1880 there died of typhoid fever per 10,000 living in 
Brooklyn, Philadelphia, Baltimore, Pittsburg, New Orleans, 
and Charleston i, 4.13, 5.14, 10.99, ^-O^t ^^^ 940. Do 
these figures represent the cleanliness of these places ? 
Albany, said the Eminent Sanitarian, as he mounted the 
sanitary platform and waved his hand with august serenity, 
Albany has 4.51 deaths from typhoid fever per 10,000 living. 
Sanitary Science explains this problem : the city takes its 
water from the Hudson, which is contaminated with the 
sewage of Troy and the towns above. But we look at 
Troy, which takes its water from the pure Piscauin Creek, 
and find that this city yields 8.45 victims to typhoid fever 
per 10,000; and after the 3,000,000 of people in New York 
and Brooklyn have eaten, the year round, the ice which 
Albany, Troy, and other towns have contaminated with 
typhoid-fever germs, Brooklyn and New York have I and 
1.7 1 typhoid-fever deaths per 10,000 living. Continuing his 
allocution, the Eminent Sanitarian said it was plain why 
Newark should have 3.51 deaths per 10,000 of its popula- 
tion from typhoid fever : its water-supply was from the 
Passaic, which was polluted by the sewage of Paterson and 
other towns ; but when the same water, still taking up sew- 
age in its course, reached Jersey City, it only caused 1.73 
typhoid deaths per 10,000. It was just as clear why the 
cesspool city of Philadelphia should have 4.13 typhoid 
deaths per 10,000. It drank the dirty water of the Schuyl- 
kill. But when we reach Washington, which is thoroughly 
sewered and supplied by the pure water of the Potomac, we 
find 4.88 typhoid-fever deaths per 10,000; and when we get 



THE VITAL STATISTICS. 453 

down to well-drained Charleston, with water eternally flow- 
ing from artesian wells 2000 feet deep, we have 9.40 
typhoid-fever deaths per io,0(X); and when we arrive at 
filthy New Orleans, with its scanty, polluted water, its pes- 
tilential air, and loathsome soil, we have only 1.98 typhoid 
deaths per 10,000 living. Pittsburg, which draws its water 
from a comparatively pure source of the Allegheny River, 
has 10.99 deaths per 10,000 from typhoid fever, while Alle- 
gheny City, whose water-supply, as we have seen on page 
124, is horribly polluted by sewers, slaughter-houses, soap- 
factories, tanneries, etc., yields 2.79 typhoid deaths per 
10,000. In whichever direction we turn we find, both in 
the vital statistics of our own and of other countries, the 
beautiful workings of that inexorable law of Sanitary 
Science that two and two make five. 

BIBLIOGRAPHY. 

Short, Bills of Mortality ; McCulloch's Statistical Account of British Em- 
pire; Malthus, Essay on Population; Mallet, Recherches Historiques sur la 
Population de Geneve; Daubrien, fitudes D6mographiques ; Casper, Die 
Wahrscheinliche Lebensdauer des Menschen; Quetelet, Recherches sur la 
Reproduction et de la Mortality des Hommes ; Bertillon, Dictionnaire Ency- 
clopedique des Sciences Medicales, Article " Mariage et Mortality ;" Tenth 
U. S. Census, Vital Statistics ; Journal of the Statistical Society of London ; 
Journal Institute of Actuaries, London ; Bertillon, La Demographic figur^e 
de la France; United States Census Bulletin No. 19, December, 1892; Ri vista 
d'Igiene et Sanita, Roma, 1892; Denmark: Its Medical Organization, Hy- 
giene, and Demography; Statistique de la France; Palmberg, Hygiene in 
Sweden ; Glatter, Ueber die Lebens Chancen der Israeliten ; Encyclopedia 
Britannica, Articles «* Vaccination," "Ireland," "Sweden," "Sewerage;" 
Report of Sub-Committee on Sanitary Condition of Liverpool; Registrar- 
General's Reports England and Wales, ist to 53d; Registrar-General's 
Reports Scotland, 1st to 34th; Registrar-General's Reports Ireland, ist to 
26th; Revue Scientifique, 1881 ; Sonstaff, Studies in Statistics. 



454 VAGARIES OF SANITARY SCIENCE. 

CHAPTER XIX. 

Conclusion. 

It is the duty, as well as the privilege, of the medical man 
to co-operate with his fellow-citizens, to the end that the air 
we breathe may be chemically of the normal quality ; that, 
besides, it shall not be tainted with obnoxious odors ; that 
our streets, parks, dwelling-houses, and places of public 
assembly shall be so constructed that there shall be a frequent 
renewal of the atmosphere ; that the abhorrent slaughter- 
house shall be banished to a point where it shall not agonize 
tender sensibilities, or harden those which are less delicate ; 
that all offensive trades shall be carried on where the com- 
munity cannot be disturbed by their sight, or smell, or 
sound ; that our sources of water-supply shall be cared for 
by practical men or women, who will be guided by common 
sense and experience in their selection, in order that the 
water we use and drink shall be as free as possible from 
extraneous matters, overflowing in quantity, sparkling to the 
eye, agreeable to the taste, and acceptable to the stomach ; 
that the soil on which we build and tread shall not be 
encumbered with refuse which is offensive to our senses; 
that, while waiting for the time to come when, stimulated 
by the hope of gain, or harassed by the fear of starvation, 
the present lavish system of the disposal of sewage shall be 
replaced by one more frugal and more consonant with the 
processes of nature, our sewers shall be so constructed that 
they will perform the service for which they were intended ; 
that our cemeteries shall be so located that they shall not 
wound persons of acute and nervous organization, and that 
our dead shall be buried with tenderness and respect ; that 
the pomp, and folly, and extravagance, and idle curiosity of 
public funerals shall be discountenanced; that if the self- 



CONCLUSION. 455 

interest and natural decency of those who are striving for 
the honor of supplying our tables are not sufficient to move 
them to keep their establishments in becoming condition, 
but if they persist in exposing their wares in a manner dis- 
gusting to eye and nose, then it is the privilege, if not the 
duty, of the people to place these dealers under restraint 
and supervision. 

If a certain portion of the community, who are pricked 
by a perverted or over-refined taste, or who are compelled 
by necessity, or incited by penuriousness, desire to eat dis- 
eased or putrid game, mutton, beef, fish, or vegetables, 
which are repugnant to the great mass of citizens, the latter 
have the right to enjoin that buyer and seller of such goods 
shall meet where no annoyance can reach the rest of the 
inhabitants. 

For the furtherance of all these measures, which promote 
comfort, decorum, and self-respect, and which tend to dignify 
the human race, through ministering purely to its material 
wants, the physician has a duty and a privilege, in common 
with his fellow-citizens. It is to the honor of the medical 
profession that its members have never shunned this duty, 
nor failed to assume this privilege, but have let their light 
so shine that it has been a guide to the pathway of others. 

But, if a body of men, for speculative purposes; or if a 
certain number, destitute of industry and talent to investi- 
gate the phenomena of nature, and titillated by irritable 
mediocrity to aspire to be nominated scientists ; or if 
amateur philanthropists, whose chief object in life is to 
break the monotony of an elegant leisure, — if any or all of 
these, to appease their thirst for the public money, or to 
satisfy their lust for power, or to delight their vanity, com- 
bine to impose on the popular mind, to excite fear and 
panic, by pretending that the air, water, soil, food, and 
public improvements are so beset by perils to health and 
life that they cannot be enjoyed by the public unless they 



456 VAGARIES OF SANITARY SCIENCE. 

are controlled, through legislative enactments, by the specu- 
lators, pseudo-scientists, and pseudo-philanthropists, it is the 
privilege of the medical practitioner to declare the humbug. 
If its promoters take the ground that, unless the terrors of 
disease and death are portrayed as the penalty, the danger 
is so great that the common herd will relapse into barbarism 
and prefer filth and misery to elegance and comfort, — then 
it is for each physician to judge how far he will lend himself 
to extend and perpetuate the delusion. 

Since the beginning, king, and noble, and pseudo-scientist 
have all been leagued and pledged to perpetrate pious 
frauds, which they said were for the people's spiritual and 
temporal good. It may be thought by some that it is better 
that the collective nervous system of civilized mankind shall 
not be prematurely shocked by the knowledge that the 
sanitarians, organized or unorganized, notwithstanding their 
pretensions, are ignorant of the causes of epidemic diseases, 
and powerless to prevent them ; and that, in upholding the 
fiction that some board is looking out for their health, the 
people are amply compensated for the frequent drafts on the 
public purse which are made by the sanitarians. Indeed, it 
may be true that mankind is happier in contentedly acqui- 
escing in that which is false than in being distressed by the 
suspense of uncertainty. The medical man, however, need 
not partake of any of these illusions. It is nothing to him 
that the reputation of professors of Sanitary Science is in 
danger if their wrangling is not quieted, as we saw on page 
39 ; or that some speculator will " not have so good a 
case" in establishing his mortuary chapel if the truth should 
be known respecting the emanations of a dead body, as we 
saw on page 211; or, as we saw on page 289, that the 
removal of certain errors regarding the cause of yellow 
fever "will paralyze sanitary legislation," and thereby preju- 
dice the interests of sanitary experts. 

But it is of immeasurable importance to mankind that the 



CONCLUSION. 457 

physician should know the true cause of disease, and that, 
while laboring and waiting for the light to dawn, he should 
distrust and resist the theory of every man — no matter how 
famous he may be — respecting such cause which is unsus- 
tained by facts; that he should elect to be forever tossed 
and agitated on a sea of doubt rather than to repose for a 
moment in the haven of error. In reality, this is the course 
which is pursued by the medical man who is engaged in 
the daily practice of his profession ; who is watching the 
inception and progress of disease and studying its various 
symptoms. While he listens patiently to many fine-spun 
hypotheses respecting the origin and treatment of disease, 
and perchance at times quotes them approvingly, yet, when 
he reaches the bedside of his patient, he lays them aside 
and trusts to his learning, common sense, and experience. 
It is not to his discredit that he prefers to confess his igno- 
rance of the Unknown rather than to lead others or be 
himself led astray. Is the fame of Louis and Chomel, and 
Bretonneau and Trousseau, and Bartlett and Jackson, and 
many others like them, any less bright or less enduring 
than if they had indulged in airy speculations regarding the 
causes of those diseases whose symptoms and morbid 
anatomy they so matchlessly displayed, but whose origin 
they frankly avowed was to them unknown ? Their candor 
saved them from the gentle scorn, if not from the lively 
ridicule, of posterity. 

Above all, it is essential to the honor and dignity of a 
profession whose members rely for their support on their 
education, talents, industry, character, and fidelity to their 
clients, that it should decline, even at the risk of being 
charged with indifference or with enmity to the public 
health, to embellish the train of a body of men who have 
diagnosed themselves as Sanitary Experts, and whose sole 
claims to public recognition consist in noisy demonstrations 
on the platform of a Sanitary Convention, 
u 39 



INDEX. 



A. 

Air, The, 50. 

of cemeteries, 186, 195, 1 98. 

of sewers, 160, 170. 

of soil, 143, 149. 
Awakening, The Great Sanitary, 29. 



Bacillus, cholera, 105, 135, 325. 

typhoid, 132, 135, 151. 
Bacteria in the soil, 148, 151. 

in water, 134. 
Board of Health, Metropolitan, 365. 

of Connecticut, 395. 

of Massachusetts, 387. 

of Michigan, 401. 

of Minnesota, 40. 

of New Hampshire, 398. 

of New Jersey, 400. 

of New York City, 369. 

of New York State, 399. 

of Pennsylvania, 400. 

of Rhode Island, 398. 

C. 

Cemeteries, 37, 181. 

dangers of, 189, 199. 

gases of, 186, 188, 195. 

of England, 185. 

of Long Island, 203. 

of New Orleans, 202. 

of Paris, 196. 
Cholera, 292. 

epidemics of, 293, 296, 301, 303, 
308, 316. 



Cholera, filth-theory of, 292, 315, 
318, 325- 
in India, 323. 
in U. S. army, 307. 
reports of epidemics of, 294, 297, 

299. 303. 
Contagion from dead body, 206. 
Cremation, 190, 199. 



Death-rate of Denmark, 415. 

of England and Wales, 429. 

of European States, 429. 

of Ireland, 433. 

of Liverpool, 446. 

of London, 442. 

of New Haven, 92. 

of New Orleans, 99. 

of Newport, 89. 

of New York City, 99. 

of Sacramento, loi. 

of Washington, 100. 
Diarrhceal diseases, 437. 
Diphtheria, 329, 438. 

causes of, 330. 

filth-origin of, 329. 

from use of milk, 327. 

in Boston, 334. 

in California, 341. 

in Connecticut, 33S. 

in England, 342. 

in France, 342. 

in Massachusetts, 331. 

in Minnesota, 340. 

in New Hampshire, 337. 
459 



460 



INDEX. 



Diphtheria in New York, 335, 373. 

in Ohio, 340. 

in the Northwest, 341. 
Duration of life, mean, 413. 



Emanations, putrid, 50, 58, 61, 62, 

79, 184, 256, 277, 316. 
Epidemics, 345. 
Exhumations, 191, 193, 200. 

F. 

Filth-diseases, 21, 52, 248. 
Food, animal, 216. 

of various tribes and nations, 
215, 218. 
Funerals, Public, 205. 

contagion at, 206, 213. 



Germ of disease in putrefaction, 105. 

Gibbons, Dr., on filth-causation of 
disease, 105. 

Graves, Dr., on filth-causation of dis- 
ease, 105. 



Heredity, 404. 
Hippocrates, 17. 



H. 



I. 



Ice, contaminated, 129. 
Influenza, 361. 



Jews, sanitary code of, 16. 

L. 

Lewis, Waller, on cemeteries, 192. 
Liebig on agriculture, 250. 

M. 

Markets of New York, 246. 
Meat, 215. 



Meat, diseased, 219, 226, 229, 244. 
in Berlin, 225. 
in China, 224. 
in England, 219. 
in Massachusetts, 2i2i. 
in New York, 228. 
in Paris, 222, 229. 
poisoning from, 227. 
putrid, 222. 
Middle Ages, hygiene of, 19. 
Milk, 231. 

cause of diphtheria, scarlatina, 
typhoid fever, and consump- 
tion, 235, 238, 241, 243. 
tuberculous, 232. 
Mortality in town and country, 35, 36. 
law of celibacy, 407. 
of education, 408. 
of heredity, 404. 
of legitimacy, 404. 
of race, 405. 
of sex, 404. 
of plumbers, 163. 



Plague, 345. 

in Florence, 347. 
in France, 348. 
in Geneva, 350. 
in Marseilles, 355. 
in Milan, 352. 

S. 

Salles de dissection, 209. 
Sanitarians, Ancient, Mediaeval, and 

Modern, 15. 
Sanitary condition of Belgium, 78. 

of Brighton, 79. 

of Canton, 76. 

of China, 71. 

of Chinatown, 102. 

of Constantinople, 63. 

of Great Britain, 29, 35, 432. 



INDEX. 



461 



Sanitary condition of Hamburg, 318. 
of Hunter's Point, 94. 
of Ireland, 423. 
of Isle of Man, 421. 
of Italy, 430. 
of Japan, 76. 
of Liverpool, 445. 
of London, 443. 
of Mount Vernon, 97. . 
of New Haven, 91. 
of Newport, 85. 
of Philadelphia, 379. 
of Sacramento, 100. 
of Scotland, 425. 
of Sea Cliff, 95. 
of summer resorts, ^t^. 
of Tivoli, 97. 
of Tunis, 70. 
inspections of public institutions, 
82, 94, lOI. 
Sewage farms, 67, 165. 
Sewer-gas, 153. 

composition of, 156. 
diseases caused by, 158. 
germs in, 172, 174, 178. 
pressure of, 175. 
properties of, 155. 
in public institutions, 165. 
Sewers of Bristol, 172. 
of London, 162. 
of Paris, 160, 164. 
Small-pox, 435. 
Soil, The, 142. 

pollution of, 145. 
Spartans, hygiene of, 18. 
Statistics, Vital, 403. 

of Denmark, 415. 

of England and Wales, 433, 

441. 
of France, 412, 427. 
of Geneva, 412. 
of Great Britain, 415. 
of Ireland, 422, 

39* 



Statistics, Vital, of Isle of Man, 422, 
of Italy, 431. 
of Jews, 405. 
of Scotland, 425. 
of Sweden, 414, 427. 
of United States, 451. 

T. 

Typhoid fever, causes of, 81, 251, 
252, 253, 279, 439. 
in Australia, 258. 
in Brighton, 80. 
in Colorado, 274. 
in Connecticut, 279. 
in Dakota, 274. 
in Dublin, 263. 
in India, 258, 261, 262. 
in Massachusetts, 267. 
in Michigan, 272. 
in New Hampshire, 271. 
in New Orleans, 277. 
in North Boston, 137. 
in Plymouth, 279. 
in Scotland, 440. 
in Vienna, 264. 
in Zurich, 244. 

W. 

Water, The, 106, 
analyses of, no. 
diseases caused by, 108. 
impure, in Alleghany City, 124. 

in Baltimore, 121. 

in Boston, 120. 

in Brooklyn, 125. 

in Connecticut, 121. 

in Gloucester, n8. 

in Jamestown, 122. 

in New York City, 124, 126. 
polluted, of the Elbe, 320. 

of the Seine, 322. 

of the Thames, 37, 44, 46, 
47, 114. 



462 



INDEX, 



Yellow Fever, 280. 

causes of, 280, 288, 289. 

filth-origin of, 286, 290. 

in Charleston, 281. 

in Florida, 291. 

in Mississippi Valley, 288. 

in Mobile, 289. 



Yellow fever in New Orleans, 284, 
288, 291. 
in New York, 286. 
in Philadelphia, 282. 



Zymotic diseases, 9, 21, 433, 441. 



THE END. 



LIBRARY OF CONGRESS ^ 



029 547 460 9 



yrk\ 

mm 













»IW^^ 






1ft 



